Abstract | BACKGROUND AND PURPOSE: METHODS: Consecutive patients with intracranial acute occlusion treated with intravenous tPA underwent transcranial Doppler examination before and 1 hour after tPA administration. Patients were categorized according to occlusion localization in proximal and distal occlusion. Sequential analysis of recanalization according to time to treatment was performed for every 30-minute cutoff point. RESULTS: Overall (n=508), 54.3% had proximal and 45.7% had distal occlusion. Median time to treatment was 171.4±61.9 minutes, and 5.9% were treated >270 minutes. Recanalization occurred in 36.1% of patients. There was no linear association between time to treatment and time to recanalization, but sequential analysis showed that patients treated >270 minutes had a lower recanalization rate. Lower National Institutes of Health Stroke Scale score on admission (odds ratio [OR], 0.305; 95% confidence interval [CI], 0.1-0.933) and time to treatment ≤270 minutes (OR, 0.995; 95% CI, 0.99-0.999) emerged as independent predictors of recanalization. In patients with proximal occlusion, 41.8% recanalized. Time to treatment >90 minutes was associated with lower recanalization rate. However, only younger age (OR, 0.975; 95% CI, 0.952-0.999) and lower baseline National Institutes of Health Stroke Scale score (OR, 0.921; 95% CI, 0.855-0.993) independently predicted recanalization. In distal occlusion patients, male sex was the only independent predictor of recanalization (OR, 0.416; 95% CI, 0.195-0.887). None recanalized >270 minutes. CONCLUSIONS: The effect of tPA on recanalization may decrease over time. Treatment >270 minutes predicted lack of recanalization, especially in distal occlusions.
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Authors | Marian Muchada, David Rodriguez-Luna, Jorge Pagola, Alan Flores, Estela Sanjuan, Pilar Meler, Sandra Boned, Jose Alvarez-Sabin, Marc Ribo, Carlos A Molina, Marta Rubiera |
Journal | Stroke
(Stroke)
Vol. 45
Issue 9
Pg. 2734-8
(Sep 2014)
ISSN: 1524-4628 [Electronic] United States |
PMID | 25104845
(Publication Type: Journal Article)
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Copyright | © 2014 American Heart Association, Inc. |
Chemical References |
- Tissue Plasminogen Activator
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Topics |
- Aged
- Brain Ischemia
(drug therapy)
- Female
- Humans
- Infarction, Middle Cerebral Artery
(drug therapy)
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Odds Ratio
- Stroke
(drug therapy)
- Thrombolytic Therapy
(methods)
- Time-to-Treatment
- Tissue Plasminogen Activator
(therapeutic use)
- Treatment Outcome
- Ultrasonography, Doppler, Transcranial
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