Intravenous rt-PA Fibrinolytic Therapy in Acute Carotid Territory Ischemic Stroke with Severe Neurologic Deficits: The Implication of Arterial Recanalization for Stroke Outcome

ABSTRACT

BACKGROUND: Our previous pilot study demonstrated that intravenous recombinant tissue plasminogen activator(rt-PA) fibrinolytic therapy was effective in treatment of effects of acute ischemic stroke within 3 hours of onset. We studied whether rt-PA was effective and safe in patients with acute carotid artery territory ischemic stroke with severe neurologic deficits (National Institute of Health Stroke Scale (NIHSS) score >14 points) and whether arterial recanalization after rt-PA infusion influenced the initial neurologic improvements within 24 hours and the stroke outcome at 3 months. METHODS: Twenty eligible patients had pre- and post-treatment computed tomogram and pre-treatment magnetic resonance angiogram. Fourteen patients had post-treatment magnetic resonance angiogram at 24 hours after stroke onset. Endpoints examined included initial neurological improvement at 2 and 24 hours by NIHSS and clinical stroke outcome at 3 months by a modified Rankin scale and the effect of recanalization on initial improvement and stroke outcome. RESULTS: Out of 20 patients, 9 patients (45%) showed initial improvement at 2 hours and 10 patients (50%) at 24 hours. Five patients (25%) had intracranial hemorrhages (symptomatic; 2). Twelve patients (60%) showed good clinical stroke outcome at 3 months. Complete or partial recanalization was observed in 11 patients (55%) at 24 hours after stroke onset. Recanalization correlated with good initial improvement and stroke outcome (p<0.05 and <0.05). CONCLUSIONS: Recanalization may have an association with good clinical outcome after rt-PA infusion within 3 hours of stroke onset in patients with acute carotid artery territory stroke with severe neurologic deficits.