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Clinical deterioration after intravenous recombinant tissue plasminogen activator treatment: a multicenter transcranial Doppler study.
Stroke. 2007 Jan; 38(1):69-74.S

Abstract

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+Show Affiliations

University of Alberta, Department of Medicine, Division of Neurology, 2 E3 Walter Mckenzie Center, 8440 112 Ave, Edmonton, Alberta T6G 2B7, Canada. msaqqur@ualberta.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

17138949

Citation

Saqqur, Maher, et al. "Clinical Deterioration After Intravenous Recombinant Tissue Plasminogen Activator Treatment: a Multicenter Transcranial Doppler Study." Stroke, vol. 38, no. 1, 2007, pp. 69-74.
Saqqur M, Molina CA, Salam A, et al. Clinical deterioration after intravenous recombinant tissue plasminogen activator treatment: a multicenter transcranial Doppler study. Stroke. 2007;38(1):69-74.
Saqqur, M., Molina, C. A., Salam, A., Siddiqui, M., Ribo, M., Uchino, K., Calleja, S., Garami, Z., Khan, K., Akhtar, N., O'Rourke, F., Shuaib, A., Demchuk, A. M., & Alexandrov, A. V. (2007). Clinical deterioration after intravenous recombinant tissue plasminogen activator treatment: a multicenter transcranial Doppler study. Stroke, 38(1), 69-74.
Saqqur M, et al. Clinical Deterioration After Intravenous Recombinant Tissue Plasminogen Activator Treatment: a Multicenter Transcranial Doppler Study. Stroke. 2007;38(1):69-74. PubMed PMID: 17138949.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical deterioration after intravenous recombinant tissue plasminogen activator treatment: a multicenter transcranial Doppler study. AU - Saqqur,Maher, AU - Molina,Carlos A, AU - Salam,Abdul, AU - Siddiqui,Muzaffar, AU - Ribo,Marc, AU - Uchino,Ken, AU - Calleja,Sergio, AU - Garami,Zsolt, AU - Khan,Khaurshid, AU - Akhtar,Naveed, AU - O'Rourke,Finton, AU - Shuaib,Ashfaq, AU - Demchuk,Andrew M, AU - Alexandrov,Andrei V, AU - ,, Y1 - 2006/11/30/ PY - 2006/12/2/pubmed PY - 2007/1/20/medline PY - 2006/12/2/entrez SP - 69 EP - 74 JF - Stroke JO - Stroke VL - 38 IS - 1 N2 - 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. SN - 1524-4628 UR - https://www.unboundmedicine.com/medline/citation/17138949/Clinical_deterioration_after_intravenous_recombinant_tissue_plasminogen_activator_treatment:_a_multicenter_transcranial_Doppler_study_ L2 - https://www.ahajournals.org/doi/10.1161/01.STR.0000251800.01964.f6?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -