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Failure of complete recanalization is associated with poor outcome after cardioembolic stroke
1Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
Insights
Complete recanalization after thrombolytic therapy is crucial for cardioembolic stroke outcomes. Failure to achieve full recanalization in these patients is common and predicts a poor prognosis.
Area of Science:
- Neurology
- Cardiology
- Vascular Medicine
Background:
- Recanalization significantly impacts outcomes following thrombolytic treatment.
- Cardiac emboli, though fibrin-rich and responsive to fibrinolysis, are linked to poor stroke outcomes and high mortality.
- The completeness of recanalization may critically influence the prognosis of cardioembolic stroke.
Purpose of the Study:
- To determine if the degree of recanalization affects outcomes in patients with cardioembolic stroke treated with fibrinolysis.
- To compare recanalization rates and outcomes between patients with and without cardiac sources of embolism (CSE).
Main Methods:
- Enrolled consecutive stroke patients with arterial occlusions on CT angiography who received thrombolytic therapy.
- Assessed recanalization completeness using the Thrombolysis in Myocardial Infarction (TIMI) grade.
- Investigated independent predictors of poor outcome (modified Rankin Scale score 3-6) at 3 months.
Main Results:
- Of 127 patients, 65 (51%) had CSE. Overall recanalization rates (TIMI 2 or 3) were similar between groups (65% vs. 68%, P=0.710).
- Patients with CSE were significantly less likely to achieve complete recanalization (TIMI 3) compared to those without (19% vs. 39%, P=0.011).
- CSE was associated with failure of complete recanalization (OR 2.809) and independently predicted poor 3-month outcome (OR 3.629).
Conclusions:
- Failure to achieve complete recanalization is frequent in cardioembolic strokes treated with thrombolysis.
- Incomplete recanalization is associated with poor outcomes after thrombolytic therapy for cardioembolic stroke.
Background:
Recanalization is strongly associated with outcomes after thrombolytic treatment. Cardiac emboli are known as better response to fibrinolytic agents because they are fibrin-rich; however, cardioembolic stroke itself is associated with poor outcomes and high mortality. Completeness of recanalization may therefore affect the outcome of cardioembolic stroke. We investigated whether degree of recanalization influences outcomes following fibrinolytic therapy in cardioembolic stroke.
Methods:
Consecutive stroke patients with relevant artery occlusions on baseline CT angiography who had received thrombolytic treatment were enrolled. Completeness of recanalization was assessed by the Thrombolysis in Myocardial Infarction (TIMI) grade, which was compared between patients with and without cardiac sources of embolism (CSE). We also investigated independent predictors of poor outcome (modified Rankin scale score 3-6) at 3 months.
Results:
Of the 127 patients enrolled, 65 (51%) had one or more CSE. Although the overall recanalization rates (TIMI 2 or 3) in patients with CSE (65%) and patients without CSE (68%) were similar (P=0.710), patients with CSE were less likely to show complete recanalization (TIMI 3) compared with those without CSE (19% vs. 39%, P=0.011). Multivariate analysis revealed that CSE was associated with failure of complete recanalization (OR 2.809, 95% CI 1.097-7.192) and was an independent predictor of poor outcome at 3months (OR 3.629, 95% CI 1.205-8.869).
Conclusions:
In cardioembolic strokes, failure of complete recanalization following thrombolytic therapy was frequent and was associated with poor outcome after thrombolysis.
