Research Article| Volume 267, ISSUE 1-2, P57-61, April 15, 2008

Download started.


Atrial fibrillation as an independent predictor for no early recanalization after IV-t-PA in acute ischemic stroke


      Background and purpose

      Intravenous administration of tissue plasminogen activator (t-PA) dissolves the clot and can improve clinical outcome in patients with acute ischemic stroke. However, lack of early recanalization frequently does not result in good outcome.


      We prospectively studied acute stroke patients treated with t-PA and examined clinical factors associated with no early recanalization of occluded arteries after t-PA administration using serial magnetic resonance angiography (MRA). NIHSS score was obtained before and at 24h after t-PA administration.


      Subjects comprised 49 consecutive stroke patients treated with t-PA. Initial MRA before t-PA infusion demonstrated occluded arteries in 37 patients. Of the 37 occluded arteries, follow-up MRA within 30min after t-PA administration revealed complete recanalization in 6 patients, partial recanalization in 12, and no early recanalization in 19. Neurological worsening (total NIHSS score increased by ≥4) occurred in 0 of 18 patients with recanalization and 4 of 19 patients with no recanalization (P=0.039). Atrial fibrillation (AF) and hypertension were more frequent in patients with non-early recanalization than in patients with recanalization (73.7% vs. 38.9%, P=0.03; 73.6% vs. 38.9%, P=0.03, respectively). However, no differences were observed in other clinical factors between groups. Multivariate logistic regression analysis demonstrated AF (OR: 9.3; CI: 1.5–55.8, P=0.015) as the only independent factor associated with no recanalization.


      No early recanalization after t-PA administration was observed in 51.4% of acute stroke patients with occluded arteries and was significantly associated with neurological worsening. AF was independently associated with no recanalization after t-PA administration.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Neurological Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hacke W.
        • Donnan G.
        • Fieschi C.
        • Kaste M.
        • von Kummer R.
        • Broderick J.P.
        • et al.
        Association of outcome with early stroke treatment: pooled analysis of atlantis, ecass, and ninds rt-PA stroke trials.
        Lancet. 2004; 363: 768-774
      1. Tissue plasminogen activator for acute ischemic stroke. The national institute of neurological disorders and stroke rt-PA stroke study group.
        N Engl J Med. 1995; 333: 1581-1587
        • Zangerle A.
        • Kiechl S.
        • Spiegel M.
        • Furtner M.
        • Knoflach M.
        • Werner P.
        • et al.
        Recanalization after thrombolysis in stroke patients: predictors and prognostic implications.
        Neurology. 2007; 68: 39-44
        • Rubiera M.
        • Alvarez-Sabin J.
        • Ribo M.
        • Montaner J.
        • Santamarina E.
        • Arenillas J.F.
        • et al.
        Predictors of early arterial reocclusion after tissue plasminogen activator-induced recanalization in acute ischemic stroke.
        Stroke. 2005; 36: 1452-1456
        • Molina C.A.
        • Alexandrov A.V.
        • Demchuk A.M.
        • Saqqur M.
        • Uchino K.
        • Alvarez-Sabin J.
        Improving the predictive accuracy of recanalization on stroke outcome in patients treated with tissue plasminogen activator.
        Stroke. 2004; 35: 151-156
        • Kim Y.S.
        • Garami Z.
        • Mikulik R.
        • Molina C.A.
        • Alexandrov A.V.
        Early recanalization rates and clinical outcomes in patients with tandem internal carotid artery/middle cerebral artery occlusion and isolated middle cerebral artery occlusion.
        Stroke. 2005; 36: 869-871
        • Delgado-Mederos R.
        • Rovira A.
        • Alvarez-Sabin J.
        • Ribo M.
        • Munuera J.
        • Rubiera M.
        • et al.
        Speed of tPA-induced clot lysis predicts DWI lesion evolution in acute stroke.
        Stroke. 2007; 38: 955-960
        • del Zoppo G.J.
        • Poeck K.
        • Pessin M.S.
        • Wolpert S.M.
        • Furlan A.J.
        • Ferbert A.
        • et al.
        Recombinant tissue plasminogen activator in acute thrombotic and embolic stroke.
        Ann Neurol. 1992; 32: 78-86
        • Alexandrov A.V.
        • Demchuk A.M.
        • Felberg R.A.
        • Christou I.
        • Barber P.A.
        • Burgin W.S.
        • et al.
        High rate of complete recanalization and dramatic clinical recovery during tPA infusion when continuously monitored with 2-mhz transcranial Doppler monitoring.
        Stroke. 2000; 31: 610-614
        • Lewandowski C.A.
        • Frankel M.
        • Tomsick T.A.
        • Broderick J.
        • Frey J.
        • Clark W.
        • et al.
        Combined intravenous and intra-arterial rt-PA versus intra-arterial therapy of acute ischemic stroke: emergency management of stroke (EMS) bridging trial.
        Stroke. 1999; 30: 2598-2605
        • Smith W.S.
        • Sung G.
        • Starkman S.
        • Saver J.L.
        • Kidwell C.S.
        • Gobin Y.P.
        • et al.
        Safety and efficacy of mechanical embolectomy in acute ischemic stroke: results of the MERCI trial.
        Stroke. 2005; 36: 1432-1438
        • Smith W.S.
        Safety of mechanical thrombectomy and intravenous tissue plasminogen activator in acute ischemic stroke. Results of the multi mechanical embolus removal in cerebral ischemia (MERCI) trial, part i. AJNR.
        Am J Neuroradiol. 2006; 27: 1177-1182
        • Yamaguchi T.
        • Mori E.
        • Minematsu K.
        • Nakagawara J.
        • Hashi K.
        • Saito I.
        • et al.
        Alteplase at 0.6mg/kg for acute ischemic stroke within 3hours of onset: Japan alteplase clinical trial (J-ACT).
        Stroke. 2006; 37: 1810-1815
        • Demchuk A.M.
        • Felburg R.A.
        • Alexandrov A.V.
        Clinical recovery from acute ischemic stroke after early reperfusion of the brain with intravenous thrombolysis.
        N Engl J Med. 1999; 340: 894-895
        • Albanese M.A.
        • Clarke W.R.
        • Adams Jr., H.P.
        • Woolson R.F.
        Ensuring reliability of outcome measures in multicenter clinical trials of treatments for acute ischemic stroke. The program developed for the trial of org 10172 in acute stroke treatment (TOAST).
        Stroke. 1994; 25: 1746-1751
        • Christou I.
        • Alexandrov A.V.
        • Burgin W.S.
        • Wojner A.W.
        • Felberg R.A.
        • Malkoff M.
        • et al.
        Timing of recanalization after tissue plasminogen activator therapy determined by transcranial Doppler correlates with clinical recovery from ischemic stroke.
        Stroke. 2000; 31: 1812-1816
        • Molina C.A.
        • Montaner J.
        • Arenillas J.F.
        • Ribo M.
        • Rubiera M.
        • Alvarez-Sabin J.
        Differential pattern of tissue plasminogen activator-induced proximal middle cerebral artery recanalization among stroke subtypes.
        Stroke. 2004; 35: 486-490
        • Saito T.
        • Tamura K.
        • Uchida D.
        • Nitta T.
        • Sugisaki Y.
        Histopathological evaluation of left atrial appendage thrombogenesis removed during surgery for atrial fibrillation.
        Am Heart J. 2007; 153: 704-711