Residual Flow Signals Predict Complete Recanalization in Stroke Patients Treated With TPA

Labiche, Lise A.; MarcMalkoffMD, Malkoff; Alexandrov, Andrei V.

doi:10.1177/1051228402239714

Cited by 35 publications

(58 citation statements)

References 18 publications

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“…Therefore, 56% of patients treated with combined i.v./i.a. thrombolysis achieved a good outcome at 3 months (mRS 0-2), compared with 22% of a previous study (Labiche et al 2003) in patients with no recanalization with i.v. thrombolysis.…”

Section: Monitoring Of Recanalizationmentioning

confidence: 82%

“…15). This classification has been demonstrated to be useful, because the degree of residual flow signals predicts the likelihood of recanalization (Labiche et al 2003). Patients with TIBI 1 to 3 have a likelihood of recanalization twice more higher than patients with TIBI 0 grade, irrespectively to the occlusion site.…”

Section: Monitoring Of Recanalizationmentioning

confidence: 99%

“…treatment (Lewandowski et al 1999;Flaherty et al 2005;Lee et al 2004;Zaidat et al 2002;Sekoranja et al 2006). Several studies described the role of TCD and TCCS as a useful tool for the diagnosis of MCA occlusion and the monitoring of its recanalization and the prognostic value of early arterial recanalization, identified by TCD, was reaffirmed in terms of good outcome at 3 months (Labiche et al 2003) for: -50% of patients with a complete recanalization -44% of patients with a partial recanalization -22% of patient without recanalization In this study 20% of patients with proximal MCA occlusion who do not recanalize within 30 min is dead at 3 months. In the Eligible study (Malferrari et al 2007;Malferrari and Zedde 2008) the subgroup of patients with MCA stenosis or occlusion had the highest recanalization rate and distal MCA lesions shown a better and earlier recanalization and a significantly lower mortality rate than proximal ones, being patent nearly 50% at 3-6 h, as in the NAIS study (Allendoerfer et al 2006).…”

Section: Monitoring Of Recanalizationmentioning

confidence: 99%

“…25. (Labiche et al 2003;Saqqur et al 2008). The grade 4 (established perfusion) comprises different hemodynamic situations: normal flow (4a), stenotic flow (4b), and high-flow velocities in hyperperfusion (4c).…”

Section: Monitoring Of Recanalizationmentioning

confidence: 99%

See 3 more Smart Citations

Neurosonological Evaluation of the Acute Stroke Patients

Malferrari¹,

Zedde²

2011

Neuroimaging for Clinicians - Combining Research and Practice

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Section: Monitoring Of Recanalizationmentioning

confidence: 82%

Section: Monitoring Of Recanalizationmentioning

confidence: 99%

Section: Monitoring Of Recanalizationmentioning

confidence: 99%

Section: Monitoring Of Recanalizationmentioning

confidence: 99%

See 2 more Smart Citations

Neurosonological Evaluation of the Acute Stroke Patients

Malferrari¹,

Zedde²

2011

Neuroimaging for Clinicians - Combining Research and Practice

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“…Although, the early recanalization of occluded artery is substantial for clinical improvement and good outcome after IVT, patients presenting with large vessel occlusion have a high probability of poor outcome with low recanalization rates [3][4][5][6][7] . Recent retrospective analysis showed only 32.1% of early recanalizations of the occluded MCA after IVT documented by angiography or by transcranial Doppler (TCD) (ref.…”

Section: Introductionmentioning

confidence: 99%

The safety and efficacy of bridging full-dose IV-IA thrombolysis in acute ischemic stroke patients with MCA occlusion: A comparison with IV thrombolysis alone

Šaňák¹,

Köcher²,

Veverka³

et al. 2014

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Aims. Early recanalization of the occluded cerebral artery is substantial for clinical improvement in acute ischemic stroke (IS) patients. The rate of achieved recanalizations using IVT is low. The aim of this study was to compare the safety and efficacy of bridging full-dose intravenous-intraarterial (IV-IA) thrombolysis to IVT alone in acute IS patients with occluded MCA. Methods. Seventy-nine consecutive IS patients with MCA occlusion were treated either with IVT alone (historic controls, Group 1) or with full-dose IV-IA thrombolysis (Group 2). Stroke severity was evaluated using NIHSS, achieved recanalizations using transcranial Doppler (Group 1) or angiography (Group 2). Occurrence of ICH including SICH was evaluated after 24 hours. 90-day clinical outcome was evaluated using modified Rankin Scale (mRS). Results. Group 1 consisted of 50 patients (24 males, mean age 70.8 ± 10.2 years) and Group 2 of 29 patients (14 males, mean age 67.8 ± 10.0 years). No difference was found in the initial NIHSS (median 16 vs. 17) and other baseline parameters including time from stroke onset to IVT. Patients treated with bridging therapy had a higher number of achieved MCA recanalization (75.9 vs. 32.0%, P=0.0002), similar number of SICH (6.0 vs. 6.9%, P =1.000) and 34.5% of them achieved mRS 0-2 versus 28.0% of patients treated with IVT (P=0.546). Patients with shorter TR had significantly better clinical outcome (P=0.019). Conclusion. Bridging IV-IA thrombolysis seems to be safe and more effective than IVT alone in acute stroke patients with MCA occlusion.

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Tenecteplase Improves Reperfusion across Time in Large Vessel Stroke

Yogendrakumar

Beharry

Чурилов

et al. 2022

Annals of Neurology

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Objective Tenecteplase improves reperfusion compared to alteplase in patients with large vessel occlusions. To determine whether this improvement varies across the spectrum of thrombolytic agent to reperfusion assessment times, we performed a comparative analysis of tenecteplase and alteplase reperfusion rates. Methods Patients with large vessel occlusion and treatment with thrombolysis were pooled from the Melbourne Stroke Registry, and the EXTEND‐IA and EXTEND‐IA TNK trials. The primary outcome, thrombolytic‐induced reperfusion, was defined as the absence of retrievable thrombus or >50% reperfusion at imaging reassessment. We compared the treatment effect of tenecteplase and alteplase, accounting for thrombolytic to assessment exposure times, via Poisson modeling. We compared 90‐day outcomes of patients who achieved reperfusion with a thrombolytic to patients who achieved reperfusion via endovascular therapy using ordinal logistic regression. Results Among 893 patients included in the primary analysis, thrombolytic‐induced reperfusion was observed in 184 (21%) patients. Tenecteplase was associated with higher rates of reperfusion (adjusted incidence rate ratio [aIRR] = 1.50, 95% confidence interval [CI] = 1.09–2.07, p = 0.01). Findings were consistent in patient subgroups with first segment (aIRR = 1.41, 95% CI = 0.93–2.14) and second segment (aIRR = 2.07, 95% CI = 0.98–4.37) middle cerebral artery occlusions. Increased thrombolytic to reperfusion assessment times were associated with reperfusion (tenecteplase: adjusted risk ratio [aRR] = 1.08 per 15 minutes, 95% CI = 1.04–1.13 vs alteplase: aRR = 1.06 per 15 minutes, 95% CI = 1.00–1.13). No significant treatment‐by‐time interaction was observed (p = 0.87). Reperfusion via thrombolysis was associated with improved 90‐day modified Rankin Scale scores (adjusted common odds ratio = 2.15, 95% CI = 1.54–3.01) compared to patients who achieved reperfusion following endovascular therapy. Interpretation Tenecteplase, compared to alteplase, increases prethrombectomy reperfusion, regardless of the time from administration to reperfusion assessment. Prethrombectomy reperfusion is associated with better clinical outcomes. ANN NEUROL 2023;93:489–499

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Residual Flow Signals Predict Complete Recanalization in Stroke Patients Treated With TPA

Cited by 35 publications

References 18 publications

Neurosonological Evaluation of the Acute Stroke Patients

Neurosonological Evaluation of the Acute Stroke Patients

The safety and efficacy of bridging full-dose IV-IA thrombolysis in acute ischemic stroke patients with MCA occlusion: A comparison with IV thrombolysis alone

Tenecteplase Improves Reperfusion across Time in Large Vessel Stroke

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