Timing of Recanalization and Functional Recovery in Acute Ischemic Stroke

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dc.contributor.authorTsivgoulis, Georgios
dc.contributor.authorSaqqur, Maher
dc.contributor.authorSharma, Vijay K.
dc.contributor.authorBrunser, Alejandro
dc.contributor.authorEggers, Jürgen
dc.contributor.authorMikulik, Robert
dc.contributor.authorKatsanos, Aristeidis H.
dc.contributor.authorSergentanis, Theodore N.
dc.contributor.authorVadikolias, Konstantinos
dc.contributor.authorPerren, Fabienne
dc.contributor.authorRubiera, Marta
dc.contributor.authorShahripour, Reza Bavarsad
dc.contributor.authorNguyen, Huy Thang
dc.contributor.authorMartínez-Sánchez, Patricia
dc.contributor.authorSafouris, Apostolos
dc.contributor.authorHeliopoulos, Ioannis
dc.contributor.authorShuaib, Ashfaq
dc.contributor.authorDerksen, Carol
dc.contributor.authorVoumvourakis, Konstantinos
dc.contributor.authorPsaltopoulou, Theodora
dc.contributor.authorAlexandrov, Anne W.
dc.contributor.authorAlexandrov, Andrei V.
dc.contributor.authorCLOTBUST-PRO investigators
dc.date.accessioned2021-08-06T15:50:16Z
dc.date.available2021-08-06T15:50:16Z
dc.date.issued2020
dc.description.abstractBackground and Purpose 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. Methods 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. Results 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-2019-01648P<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). Conclusions 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.es
dc.identifier.citationJournal of Stroke, 2020, vol.22(1):130-140es
dc.identifier.urihttps://doi.org/10.5853/jos.2019.01648es
dc.identifier.urihttp://hdl.handle.net/11447/4248
dc.language.isoenes
dc.subjectThrombolysises
dc.subjectStrokees
dc.subjectReperfusiones
dc.subjectOutcomeses
dc.titleTiming of Recanalization and Functional Recovery in Acute Ischemic Strokees
dc.typeArticlees

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