Early stroke treatment with IV t-PA associated with early recanalization

J Neurol Sci. 2010 Aug 15;295(1-2):53-7. doi: 10.1016/j.jns.2010.05.012. Epub 2010 Jun 8.

Abstract

Purpose: Time from stroke onset to treatment (OTT) is potentially an important factor affecting subsequent outcome in patients treated with t-PA. The aim of the study was to assess the correlation between OTT and early recanalization rate after IV-t-PA therapy.

Methods: Consecutive stroke patients treated with t-PA within 3h of onset were prospectively studied. Patients with major brain artery occlusion on MRA before t-PA infusion were enrolled. The correlation between OTT and the early recanalization rate within 1h after t-PA infusion was determined.

Results: 102 patients (M1 occlusion, 41 patients; M2, 19; ICA, 31; BA, 8; and PCA, 3) were enrolled. Follow-up MRA within 1h after t-PA infusion showed early recanalization in 42 (41.2%) patients (complete in 13 patients, partial in 29). The early recanalization rate was 53.8% with OTT <or=100 min, 57.1% in 101-110 min, 50.0% in 111-120 min, 63.6% in 121-130 min, 33.3% in 131-140 min, 30.0% in 141-150 min, 36.4% in 151-160 min, 18.2% in 161-170 min, and 32.0% in 171-180 min. OTT was negatively correlated with the early recanalization rate (r=-0.767, P=0.0301). After adjusting the presence of age (>74), ICA occlusion, baseline NIHSS score (<10), and glucose (>150 mg/dl), adjusted OR for early recanalization of OTT <or=130 min against OTT >130-180 min was 2.97 (95% CI 1.27-6.96, P=0.012).

Conclusion: Early recanalization depended on time from stroke onset to IV-t-PA administration. Thus, t-PA should be given to acute stroke patients as soon as possible.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cerebral Hemorrhage / etiology
  • Female
  • Fibrinolytic Agents / administration & dosage*
  • Fibrinolytic Agents / adverse effects
  • Humans
  • Injections, Intravenous / methods
  • Magnetic Resonance Angiography / methods
  • Magnetic Resonance Imaging / methods
  • Male
  • Middle Aged
  • Neurologic Examination / methods
  • Prospective Studies
  • Retrospective Studies
  • Severity of Illness Index
  • Statistics, Nonparametric
  • Stroke / drug therapy*
  • Time Factors
  • Tissue Plasminogen Activator / administration & dosage*
  • Tissue Plasminogen Activator / adverse effects

Substances

  • Fibrinolytic Agents
  • Tissue Plasminogen Activator