Effects of Spontaneous Recanalization on Functional and Electrophysiological Recovery in Acute Ischemic Stroke

Abstract

Background and Purpose-Transcranial Doppler ultrasound (TCD) studies have shown that spontaneous recanalization results in a better clinical improvement after the onset of stroke. However, its effect on electrophysiological recovery is still unknown. The aim of this study was to determine the effects of spontaneous recanalization on the change in central motor conduction time (CMCT) in acute ischemic stroke. Methods-Seventeen healthy subjects and 38 consecutive patients with a first acute ischemic stroke involving the middle cerebral artery territory were included. TCD was used to detect spontaneous recanalization. Transcranial magnetic stimulation was used to determine the change in CMCT on days 1 and 14. Improvement of the CMCT at day 14 was indicated if it decreased in comparison with previous data recorded at day 1 or when a nonrecordable motor response at day 1 reappeared at day 14. No CMCT improvement was indicated when there was no recordable motor response at day 1 and day 14 or the CMCT at day 14 worsened, becoming absent or more delayed. The Pearson 2 test was used to assess the statistical significance of the results in this study. Results-Spontaneous recanalization was observed in 62% of the patients: 24% before 24 hours and 38% after this period.No recanalization was observed in 14 patients. The CMCT improved in 87% of the patients who had recanalized before 24 hours and 62% in the recanalized after 24 hours group (Pϭ0.005). In contrast, CMCT improved in only 17% of the patients in the non-recanalized group Conclusions-These data show that spontaneous recanalization results in a better recovery of the central motor pathway leading to a better CMCT improvement in acute ischemic stroke. (Stroke. 1999;30:2119-2125.)

Thrombolytic Therapy in Acute Ischaemic Stroke

“…Arterial patency on angiography has been found to be an independent predictor of early improvement [15], whereas the initial clinical picture, as shown in this study and others, is of limited value [16]. Seven of our patients showed an early clinical improvement of >10 SSS points in the first 2 h after thrombolytic treatment, and 3 in the first 24 h. These findings may be compatible with an early tPA effect, but it is impossible to exclude improvement due to early spontaneous recanalisation, which may occur in 25% of patients during the first 24 h [17, 18]. …”

The Impact of Prior Antithrombotic Status on Cerebral Infarction in Patients with Atrial Fibrillation

“…11 Therefore, there is a possibility that the size of the clot decreased during the embolization through the cerebral vessels, or the fragile embolus was broken down to small clots and migrated distally after the initial occlusion of the large artery. 12 Multiterritorial infarction, a representative lesion pattern of cardioembolic stroke, was not observed in patients under OAC. Instead, single subcortical infarctions were more common in patients under OAC than in patients taking no antithrombotic medication.…”

Admission international normalized ratio and acute infarct volume in ischemic stroke

“…Even subtle changes in thrombus size during the hyperacute phase in high-flow high-pressure arterial systems may result in significant alterations in tissue outcome. 18 It is also possible that therapeutic INR leads to smaller infarct size by preventing microvascular thrombosis in the penumbral regions where there is sluggish flow.…”