Document Detail


Clinical deterioration after intravenous recombinant tissue plasminogen activator treatment: a multicenter transcranial Doppler study.
MedLine Citation:
PMID:  17138949     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: Patients may experience clinical deterioration (CD) after treatment with intravenous recombinant tissue plasminogen activator (rt-PA). We evaluated the ability of flow findings on transcranial Doppler to predict CD and outcomes on modified Rankin Scale. METHODS: Patients with acute stroke received intravenous rt-PA within 3 hours of symptom onset at four academic centers. CD was defined as an increase in the National Institutes of Health Stroke Scale (NIHSS) score by 4 points or more within 24 hours. Poor long-term outcome was defined by modified Rankin Scale > or =2 at 3 months. Transcranial Doppler findings were interpreted using the Thrombolysis in Brain Ischemia flow grading system as persistent arterial occlusion, reocclusion, or complete recanalization. Multiple regression analysis was used to identify transcranial Doppler flow as a predictor for CD after controlling for age, sex, baseline NIHSS, hypertension, and glucose. RESULTS: A total of 374 patients received intravenous rt-PA at 142+/-60 minutes (median pretreatment NIHSS score 16 points). At the end of intravenous rt-PA infusion, transcranial Doppler showed persistent arterial occlusion in 219 patients (59%), arterial reocclusion in 54 patients (14%), and complete recanalization in 101 patients (27%). CD occurred in 44 patients: 36 had persistent arterial occlusion or reocclusion (82%), 13 symptomatic intracerebral hemorrhage (29%), and both persistent occlusion/reocclusion and symptomatic intracerebral hemorrhage in 10 patients (23%). After adjustment, patient risk for CD with persistent occlusion was OR 1.7 (95% CI: 0.7 to 4) and with arterial reocclusion 4.9 (95% CI: 1.7 to 13) (P=0.002). Patient risk for poor long-term outcomes with persistent occlusion, partial recanalization, or reocclusion was OR 5.2 (95% CI: 2.7 to 9, P=0.001). CONCLUSIONS: Inability to achieve or sustain vessel patency at the end of rt-PA infusion correlates with the likelihood of clinical deterioration and poor long-term outcome. Early arterial reocclusion on transcranial Doppler is highly predictive of CD and poor outcome.
Authors:
Maher Saqqur; Carlos A Molina; Abdul Salam; Muzaffar Siddiqui; Marc Ribo; Ken Uchino; Sergio Calleja; Zsolt Garami; Khaurshid Khan; Naveed Akhtar; Finton O'Rourke; Ashfaq Shuaib; Andrew M Demchuk; Andrei V Alexandrov;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, N.I.H., Extramural     Date:  2006-11-30
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  38     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2007 Jan 
Date Detail:
Created Date:  2006-12-25     Completed Date:  2007-01-19     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  69-74     Citation Subset:  IM    
Affiliation:
University of Alberta, Department of Medicine, Division of Neurology, 2 E3 Walter Mckenzie Center, 8440 112 Ave, Edmonton, Alberta T6G 2B7, Canada. msaqqur@ualberta.ca
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Brain Ischemia / drug therapy*,  physiopathology,  ultrasonography*
Cerebral Arteries / drug effects,  physiopathology,  ultrasonography
Cerebral Hemorrhage / chemically induced,  physiopathology,  ultrasonography
Female
Fibrinolytic Agents / adverse effects
Humans
Male
Middle Aged
Predictive Value of Tests
Prognosis
Recombinant Fusion Proteins / adverse effects
Recurrence
Retrospective Studies
Stroke / drug therapy*,  physiopathology,  ultrasonography*
Time Factors
Tissue Plasminogen Activator / adverse effects*
Ultrasonography, Doppler, Transcranial
Grant Support
ID/Acronym/Agency:
K23-0229//PHS HHS
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; 0/Recombinant Fusion Proteins; EC 3.4.21.68/Tissue Plasminogen Activator

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