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The hemodynamic status within 24 h after intravenous thrombolysis predicts infarct growth in acute ischemic stroke

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Abstract

A rapid and complete recanalization of the occluded artery is the ideal goal when intravenous (IV) recombinant tissue plasminogen activator (rt-PA) is administrated to patients with acute ischemic stroke, i.e., limiting the ongoing ischemia to achieve a better outcome. We explored the effect of complete versus partial recanalization of the occluded intracranial artery after IV thrombolysis on the infarct growth and evaluated the functional impact. Using diffusion-weighted (DWI) volumetric measurements before rt-PA administration (DWI1) and 24 h later (DWI2), we calculated the infarct growth in 36 consecutive patients with ischemic stroke treated with IV rt-PA, with the formula DWI2/DWI1. Recanalization of the affected artery was assessed by transcranial Doppler (TCD) and magnetic resonance angiography (MRA) within 24 h of stroke onset. Three patients were eliminated from the analysis; 33 patients were fully analyzed (men: n = 23; mean (SD) age: 72.4 ± 16 years; time from stroke onset to rt-PA: 179 ± 54 min; mean NIHSS score at admission: 17). Patients achieving full recanalization by TCD had a smaller infarct growth, compared to those who had a partial or persistent occlusion after thrombolysis: 1.86 versus 2.91 (P = 0.017). This difference was not significant using MRA criteria: 2.01 versus 2.69 (P = 0.193). In the regression analysis, complete recanalization by TCD was an independent predictor of infarct growth (P = 0.045). Thus, complete recanalization measured by TCD within 24 h of IV thrombolysis was independently associated with smaller infarct growth.

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Authors and Affiliations

  1. Assistance Publique des Hôpitaux de Paris (APHP) et Université Pierre et Marie Curie (UPMC) Paris Universitas, Urgences Cerebrovasculaires, Groupe Hospitalier Pitié-Salpêtrière, 47-83, Boulevard de l′Hôpital, 75651, Paris Cedex, France

    José Fidel Baizabal-Carvallo, Charlotte Rosso, Christine Pires & Yves Samson

  2. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico

    Marlene Alonso-Juarez

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  1. José Fidel Baizabal-Carvallo
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  2. Charlotte Rosso
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  3. Marlene Alonso-Juarez
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  4. Christine Pires
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  5. Yves Samson
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Correspondence to José Fidel Baizabal-Carvallo.

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Baizabal-Carvallo, J.F., Rosso, C., Alonso-Juarez, M. et al. The hemodynamic status within 24 h after intravenous thrombolysis predicts infarct growth in acute ischemic stroke. J Neurol 259, 1045–1050 (2012). https://doi.org/10.1007/s00415-011-6295-3

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  • DOI: https://doi.org/10.1007/s00415-011-6295-3

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