Failure of complete recanalization is associated with poor outcome after cardioembolic stroke

• Published in: European journal of neurology Vol. 18; no. 9; pp. 1171 - 1178
• Main Authors: Nam, H. S., Lee, K.-Y., Kim, Y. D., Choi, H.-Y., Cho, H.-J., Cha, M.-J., Nam, C. M., Heo, J. H.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.09.2011; John Wiley & Sons, Inc
• Subjects: Aged; Angiography; Angiography, Digital Subtraction; Arteries; cardiac embolism; Catheters; cerebral infarction; Embolism; Female; fibrin; Heart; Heart attacks; Heart Diseases - complications; Humans; Intracranial Embolism - drug therapy; Intracranial Embolism - etiology; Male; Middle Aged; Mortality; Multivariate analysis; Myocardial infarction; Occlusion; prognosis; Recovery of Function; Risk Factors; Stroke; Stroke - drug therapy; Stroke - pathology; thrombolysis; Thrombolytic Therapy; Tissue Plasminogen Activator - therapeutic use; Urokinase-Type Plasminogen Activator - therapeutic use
• ISSN: 1351-5101; 1468-1331
• DOI: 10.1111/j.1468-1331.2011.03360.x

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 3 months (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.