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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
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Timing of Recanalization and Functional Recovery in Acute Ischemic Stroke
Georgios Tsivgoulis1,2,3, Maher Saqqur4,5, Vijay K Sharma6
1Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA.
Journal of Stroke
|February 7, 2020
Summary
Achieving early recanalization within one hour of intravenous tissue plasminogen activator (tPA) treatment significantly improves functional recovery and survival in acute ischemic stroke (AIS) patients. This faster reperfusion is key to better outcomes.
Area of Science:
- Neurology
- Vascular Neurology
- Emergency Medicine
Background:
- Onset-to-treatment time impacts early recovery in acute ischemic stroke (AIS) patients receiving intravenous tissue plasminogen activator (tPA).
- The precise effect of recanalization timing on functional outcomes after tPA is not fully established.
Purpose of the Study:
- To investigate if early complete or partial recanalization within 1 hour of tPA administration improves patient outcomes.
- To assess the association between early recanalization and dramatic clinical recovery, functional independence, and mortality in AIS patients with proximal occlusions.
Main Methods:
- A multicenter, prospective observational cohort study involving 480 AIS patients.
- Real-time transcranial Doppler monitoring was used to assess recanalization within 2 hours of tPA-bolus.
- Outcomes included dramatic clinical recovery, 3-month mortality, favorable functional outcome (FFO), and functional independence (FI).
Main Results:
- 53% of patients achieved early recanalization.
- Early recanalization was linked to significantly higher rates of dramatic clinical recovery (2-hour and 24-hour), 3-month FFO, and functional independence.
- Patients with early recanalization had significantly lower 3-month mortality rates and better modified Rankin Scale scores.
- Early recanalization independently predicted better functional outcomes and survival, even after adjusting for confounders.
Conclusions:
- Earlier tPA treatment leads to faster recanalization.
- Achieving recanalization earlier after stroke onset is associated with improved functional recovery and survival in AIS patients with proximal intracranial occlusions.
