Timing of Recanalization and Functional Recovery in Acute Ischemic Stroke

Although onset-to-treatment time is associated with early clinical recovery in acute ischemic stroke (AIS) patients treated with intravenous tissue plasminogen activator (tPA), the effect of the timing of tPA-induced recanalization on functional outcomes remains debatable. We conducted a multicenter...

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Detalles Bibliográficos
Autores: Tsivgoulis, Georgios|||0000-0002-0640-3797, Saqqur, Maher, Sharma, Vijay K., Brunser, Alejandro, Eggers, Jürgen, Mikulik, Robert, Katsanos, Aristeidis H.|||0000-0002-6359-0023, Sergentanis, Theodore N., Vadikolias, Konstantinos, Perren, Fabienne, Rubiera Del Fueyo, Marta A.|||0000-0001-8100-9477, Bavarsad Shahripour, Reza, Nguyen, Huy Thang, Martínez-Sánchez, Patricia, Safouris, Apostolos, Heliopoulos, Ioannis, Shuaib, Ashfaq, Derksen, Carol, Voumvourakis, Konstantinos I., Psaltopoulou, Theodora, Alexandrov, Andrei V.|||0000-0001-8871-1023
Tipo de recurso: artículo
Fecha de publicación:2020
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:226246
Acceso en línea:https://ddd.uab.cat/record/226246
https://dx.doi.org/urn:doi:10.5853/jos.2019.01648
Access Level:acceso abierto
Palabra clave:Thrombolysis
Stroke
Reperfusion
Outcomes
Descripción
Sumario:Although onset-to-treatment time is associated with early clinical recovery in acute ischemic stroke (AIS) patients treated with intravenous tissue plasminogen activator (tPA), the effect of the timing of tPA-induced recanalization on functional outcomes remains debatable. We conducted a multicenter, prospective observational cohort study to determine whether early (within 1-hour from tPA-bolus) complete or partial recanalization assessed during 2-hour real-time transcranial Doppler monitoring is associated with improved outcomes in patients with proximal occlusions. Outcome events included dramatic clinical recovery (DCR) within 2 and 24-hours from tPA-bolus, 3-month mortality, favorable functional outcome (FFO) and functional independence (FI) defined as modified Rankin Scale (mRS) scores of 0-1 and 0-2 respectively. We enrolled 480 AIS patients (mean age 66±15 years, 60% men, baseline National Institutes of Health Stroke Scale score 15). Patients with early recanalization (53%) had significantly (jos-2019-01648 P <0.001) higher rates of DCR at 2-hour (54% vs. 10%) and 24-hour (63% vs. 22%), 3-month FFO (67% vs. 28%) and FI (81% vs. 39%). Three-month mortality rates (6% vs. 17%) and distribution of 3-month mRS scores were significantly lower in the early recanalization group. After adjusting for potential confounders, early recanalization was independently associated with higher odds of 3-month FFO (odds ratio [OR], 6.19; 95% confidence interval [CI], 3.88 to 9.88) and lower likelihood of 3-month mortality (OR, 0.34; 95% CI, 0.17 to 0.67). Onset to treatment time correlated to the elapsed time between tPA-bolus and recanalization (unstandardized linear regression coefficient, 0.13; 95% CI, 0.06 to 0.19). Earlier tPA treatment after stroke onset is associated with faster tPA-induced recanalization. Earlier onset-to-recanalization time results in improved functional recovery and survival in AIS patients with proximal intracranial occlusions.

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