Recanalization after intravenous thrombolysis

Gotkine, Marc; Rosenberg, G; Steiner, Israel

doi:10.1212/01.wnl.0000260604.26469.8e

Cited by 82 publications

(62 citation statements)

References 27 publications

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“…It provides functional and prognostic information valuable for individual patient management (Allendoerfer et al, 2006;Nedelmann et al, 2009;Perren et al, 2006;Wunderlich et al, 2007). Next to diagnostic applications, randomized clinical studies suggest therapeutic efficacy of ultrasound on recanalization of acute cerebral artery occlusion in terms of an acceleration of fibrinolysis with recombinant tissue-type plasminogen activator (rt-PA) (Alexandrov et al, 2004;Eggers et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

Combined Contrast-Enhanced Ultrasound and rt-PA Treatment is Safe and Improves Impaired Microcirculation after Reperfusion of Middle Cerebral Artery Occlusion

Nedelmann

Ritschel

Doenges

et al. 2010

J Cereb Blood Flow Metab

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In monitoring of recanalization and in sonothrombolysis, contrast-enhanced ultrasound (CEUS) is applied in extended time protocols. As extended use may increase the probability of unwanted effects, careful safety evaluation is required. We investigated the safety profile and beneficial effects of CEUS in a reperfusion model. Wistar rats were subjected to filament occlusion of the right middle cerebral artery (MCA). Reperfusion was established after 90 minutes, followed by recombinant tissue-type plasminogen activator (rt-PA) treatment and randomization to additional CEUS (contrast agent: SonoVue; 60 minutes). Blinded outcome evaluation consisted of magnetic resonance imaging (MRI), neurologic assessment, and histology and, in separate experiments, quantitative 3D nano-computed tomography (CT) angiography (900 nm 3 voxel size). Nano-CT revealed severely compromised microcirculation in untreated animals after MCA reperfusion. The rt-PA partially improved hemispheric perfusion. Impairment was completely reversed in animals receiving rt-PA and CEUS. This combination was more effective than treatment with either CEUS without rt-PA or rt-PA and ultrasound or ultrasound alone. In MRI experiments, CEUS and rt-PA treatment resulted in a significantly reduced ischemic lesion volume and edema formation. No unwanted effects were detected on MRI, histology, and intracranial temperature assessment. This study shows that CEUS and rt-PA is safe in the situation of reperfusion and displays beneficial effects on the level of the microvasculature.

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Section: Introductionmentioning

confidence: 99%

Combined Contrast-Enhanced Ultrasound and rt-PA Treatment is Safe and Improves Impaired Microcirculation after Reperfusion of Middle Cerebral Artery Occlusion

Nedelmann

Ritschel

Doenges

et al. 2010

J Cereb Blood Flow Metab

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“…12 Observations from previous studies also suggest that recanalization with rt-PA is better with more distal occlusions than proximal and worse for ICA and tandem occlusions, as was observed in our study. [13][14] Because early recanalization is an important determinant of good outcome, assessment for the same is critical after thrombolytic therapy. Timely endovascular recanalization may be a strong consideration when the target vessel oc- Atrial fibrillation (n) 32% (40) 26% (7) 31% (18) 37% (15) 0.660…”

Section: Discussionmentioning

confidence: 99%

Low Rates of Acute Recanalization With Intravenous Recombinant Tissue Plasminogen Activator in Ischemic Stroke

Bhatia

Hill

Shobha

et al. 2010

Stroke

658

434

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Background and Purpose-Acute rates of recanalization after intravenous (IV) recombinant tissue plasminogen activator (rt-PA) in proximal vessel occlusion have been estimated sparingly, typically using transcranial Doppler (TCD). We aimed to study acute recanalization rates of IV rt-PA in CT angiogram-proven proximal (internal carotid artery [ICA], M1 middle cerebral artery [MCA], M2-MCA, and basilar artery) occlusions and their effects on outcome. Materials and Methods-The CT angiogram database of the Calgary stroke program was reviewed for the period 2002 to 2009. All patients with proximal vessel occlusions receiving IV rt-PA who were assessed for recanalization by TCD or angiogram (for acute endovascular treatment) were included for analysis. Rates of acute recanalization as observed on TCD/first run of angiogram and postendovascular therapy recanalization rates were noted. Modified Rankin Scale score Յ2 at 3 months was used as a good outcome. Results-Among 1341 patients in the CT angiogram database, 388 patients with proximal occlusion were identified. Of these, 216 patients had received IV rt-PA; 127 patients underwent further imaging to assess recanalization. Among the patients undergoing TCD (nϭ46) and cerebral angiogram (nϭ103), only 27 (21.25%) patients had acute recanalization. By occlusion subtype, the rates of recanalization were: distal ICA (with or without ICA neck occlusion or stenotic disease) 1 of 24 (4.4%); M1-MCA (with or without ICA neck occlusion or stenotic disease) 21 of 65 (32.3%); M2-MCA 4 of 13 (30.8%); and basilar artery 1 of 25 (4%). Onset to rt-PA time was comparable in patients with and without recanalization. Recanalization (PϽ0.0001; risk ratio, 2.7; 95% confidence interval, 1.5-4.6) was the strongest predictor of outcome (adjusted for age and National Institutes of Health Stroke Scale score). Key Words: intracranial occlusion Ⅲ ischemic stroke Ⅲ recanalization Ⅲ thrombolysis I ntravenous (IV) recombinant tissue plasminogen activator (rt-PA) treatment for acute ischemic stroke 1,2 works by achieving recanalization of intracranial occlusion resulting in restoration of flow and prevention of infarct expansion. 3 Data on recanalization after IV thrombolysis are limited to small angiographic and transcranial Doppler (TCD) monitoring studies. 4 None of the major IV thrombolysis trials has assessed the baseline occlusion status or recanalization rates after treatment. In an era when there is increasing use of endovascular therapies for recanalization, in the absence of robust evidence from randomized controlled trials, there is a desperate need for clear data on the rates of recanalization with IV rt-PA. 5 The present study reports the rates of acute recanalization of proximal intracranial vessel occlusions identified by baseline CT angiography (CTA) among acute ischemic stroke patients treated with IV rt-PA. Conclusions- Patients and MethodsWe identified patients presenting with acute ischemic stroke secondary to major vessel occlusion from the CT Angiography database of the Calgary St...

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“…After adjustment for baseline stroke severity, the TTT was still a significant predictor of full MCA-M1 recanalization at 24 hours. To our knowledge, most studies in the literature did not report time dependency of full MCA-M1 recanalization 24 hours after IV thrombolysis, 19,25 probably because they only dealt with patients treated within the 3-hour time window, whereas the current series is a post-European Cooperative Acute Stroke Study III 9 series, with 42% of the patients treated beyond 3 hours after stroke onset. It is well known that the longer a clot persists over time, the denser and more resistant to fibrinolysis it becomes, until a hard clot-for example, a fibrin-attenuated clot-is formed.…”

Section: Influence Of Time-to-treatment On Post-iv Thrombolysis Recanmentioning

confidence: 95%

Perfusion-Weighted Imaging–Derived Collateral Flow Index is a Predictor of MCA M1 Recanalization after IV Thrombolysis

Nicoli

Micheaux

Girard

2012

AJNR Am J Neuroradiol

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Recanalization after intravenous thrombolysis

Abstract: Complete recanalization up to 24 hours after stroke onset is significantly associated with the short-term clinical course and functional outcome 30 days after acute stroke.

Cited by 82 publications

References 27 publications

Combined Contrast-Enhanced Ultrasound and rt-PA Treatment is Safe and Improves Impaired Microcirculation after Reperfusion of Middle Cerebral Artery Occlusion

Combined Contrast-Enhanced Ultrasound and rt-PA Treatment is Safe and Improves Impaired Microcirculation after Reperfusion of Middle Cerebral Artery Occlusion

Low Rates of Acute Recanalization With Intravenous Recombinant Tissue Plasminogen Activator in Ischemic Stroke

Perfusion-Weighted Imaging–Derived Collateral Flow Index is a Predictor of MCA M1 Recanalization after IV Thrombolysis

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