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Differential pattern of tissue plasminogen activator-induced proximal middle cerebral artery recanalization among

Carlos A Molina1, Joan Montaner, Juan F Arenillas

  • 1Neurovascular Unit, Department of Neurology, Hospital Vall d'Hebrón, Passeig Vall d'Hebrón 119-129, 08035 Barcelona, Spain. cmolina@vhebrom.net

Stroke
|January 7, 2004
PubMed
Abstract

Insights

Tissue plasminogen activator (tPA) effectively recanalizes the middle cerebral artery (MCA) in stroke patients. Cardioembolic strokes show faster and more complete recanalization with tPA compared to other stroke types.

Area of Science:

  • Neuroscience
  • Neurology
  • Vascular Medicine

Background:

  • Acute ischemic stroke due to proximal middle cerebral artery (MCA) occlusion requires timely recanalization.
  • Intravenous tissue plasminogen activator (tPA) is a standard treatment for acute ischemic stroke.
  • Understanding recanalization patterns in different stroke subtypes is crucial for treatment optimization.

Purpose of the Study:

  • To evaluate the timing, speed, and degree of tPA-induced recanalization in patients with proximal MCA occlusion.
  • To compare recanalization patterns across different stroke subtypes: large-vessel disease, cardioembolic, and undetermined origin.

Main Methods:

  • Seventy-two patients with acute stroke and proximal MCA occlusion treated with intravenous tPA within 3 hours were analyzed.
  • Transcranial Doppler (TCD) monitoring assessed recanalization during tPA infusion and at 6 hours.
  • Strokes were classified according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria.

Main Results:

  • Recanalization occurred in 47% of patients within 1 hour of tPA infusion, with patterns including sudden (32%), stepwise (50%), and slow (18%).
  • One-hour recanalization was significantly more frequent in cardioembolic strokes (59%) compared to large-vessel disease (8%) and undetermined origin (50%) strokes.
  • Complete recanalization at 6 hours and sudden clot lysis were more common in cardioembolic strokes and associated with better neurological outcomes.

Conclusions:

  • The pattern of tPA-induced MCA recanalization varies significantly among different stroke subtypes.
  • Cardioembolic stroke patients exhibit more frequent, rapid, and complete recanalization following tPA treatment.
  • These findings highlight the importance of identifying stroke etiology for predicting tPA response and guiding treatment strategies.

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