Time Course of Tissue Plasminogen Activator–Induced Recanalization in Acute Cardioembolic Stroke

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Abstract
Background and Purpose — The relationship between arterial recanalization, infarct size, and outcome in patients treated with intravenous thrombolytics remains unclear. Therefore, we aimed to determine the time course of recombinant tissue plasminogen activator (rtPA)-induced recanalization in patients with cardioembolic stroke treated Methods — We prospectively studied 72 patients with an acute cardioembolic stroke in the middle cerebral artery territory: 24 treated with rtPA at Results — Rate of 6-hour recanalization was higher ( P P 3 in rtPA patients and 124.8±81.6 cm 3 in controls ( P P P =0.037) became functionally independent (modified Rankin Scale score ≤2). A close relationship ( P =0.002) existed between modified Rankin Scale score at 3 months and time to reperfusion. In addition, clinical outcome was associated strongly ( P =0.001) with degree of 6-hour recanalization. Logistic regression analysis identified National Institutes of Health Stroke Scale score P =0.001) and early recanalization (odds ratio 23.4, 95% confidence interval 5.4 to 96, P =0.001) as independent predictors of functional independence at 3 months. Conclusions — Intravenous rtPA is associated with early recanalization, which leads to lower infarct size and better clinical outcome. Early recanalization is a powerful independent predictor of functional independence at 3 months.