Speed of tPA-induced clot lysis predicts DWI lesion evolution in acute stroke

Raquel Delgado-Mederos, Alex Rovira, José Alvarez-Sabín, Marc Ribó, Josep Munuera, Marta Rubiera, Esteban Santamarina, Olga Maisterra, Pilar Delgado, Joan Montaner, Carlos A. Molina

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Abstract

BACKGROUND AND PURPOSE - We sought to evaluate the impact of the speed of recanalization on the evolution of diffusion- weighted imaging (DWI) lesions and outcome in stroke patients treated with tissue-type plasminogen activator (tPA). METHODS - We evaluated 113 consecutive stroke patients with a middle cerebral artery occlusion who were treated with intravenous tPA. All patients underwent multiparametric magnetic resonance imaging studies, including DWI and perfusion-weighted imaging before and 36 to 48 hours after administration of a tPA bolus. Patients were continuously monitored with transcranial Doppler during the first 2 hours after tPA administration. The pattern of recanalization on transcranial Doppler was defined as sudden (<1 minute), stepwise (1 to 29 minutes), or slow (>30 minutes). RESULTS - During transcranial Doppler monitoring, 13 (12.3%) patients recanalized suddenly, 32 (30.2%) recanalized in a stepwise manner, and 18 (17%) recanalized slowly. Baseline clinical and imaging parameters were similar among recanalization subgroups. At 36 to 48 hours, DWI lesion growth was significantly (P=0.001) smaller after sudden (3.23±10.5 cm) compared with stepwise (24.9±37 cm), slow (46.3±38 cm), and no (51.7±34 cm) recanalization. The slow pattern was associated with greater DWI growth (P=0.003), lesser degree of clinical improvement (P=0.021), worse 3-month outcome (P=0.032), and higher mortality (P=0.003). CONCLUSIONS - The speed of tPA-induced clot lysis predicts DWI lesion evolution and clinical outcome. Unlike sudden and stepwise patterns, slow recanalization is associated with greater DWI lesion growth and poorer short- and long-term outcomes. © 2007 American Heart Association, Inc.
Original languageEnglish
Pages (from-to)955-960
JournalStroke
Volume38
Issue number3
DOIs
Publication statusPublished - 1 Mar 2007

Keywords

  • Reperfusion
  • Stroke
  • Transcranial Doppler
  • Treatment
  • Ultrasound

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    Delgado-Mederos, R., Rovira, A., Alvarez-Sabín, J., Ribó, M., Munuera, J., Rubiera, M., Santamarina, E., Maisterra, O., Delgado, P., Montaner, J., & Molina, C. A. (2007). Speed of tPA-induced clot lysis predicts DWI lesion evolution in acute stroke. Stroke, 38(3), 955-960. https://doi.org/10.1161/01.STR.0000257977.32525.6e