Highlights
- •The likelihood of disability is known to increase with each recurrent stroke.
- •IV re-thrombolysis is exceptionally reported after recurrent stroke.
- •IV re-thrombolysis may be safe and effective after recurrent stroke.
- •Our review can serve as an approximate guide for clinicians.
Abstract
Background
The likelihood of severe disability and death increases with each recurrent stroke.
Repeated intravenous (IV) thrombolysis remains one of the therapeutic options when
secondary prevention fails; however, its effects after recurrent stroke are largely
unknown.
The aim of the present review was to assess the risks and benefits of IV re-thrombolysis
after recurrent stroke as compared with IV thrombolysis after index stroke.
Methods
We identified 8 patients who repeated IV thrombolysis after recurrent stroke from
among the 615 consecutive stroke patients who received IV thrombolysis at our Stroke
Unit and 22 cases of IV re-thrombolysed patients extracted for the literature review
of case reports and case series.
Results
After excluding the 6 patients treated with endovascular procedures, we included in
the analyses 21 patients for which we had data on pre-stroke functional status and
baseline neurological severity for each stroke event and post-treatment functional
status for each IV thrombolysis. We compared second (n = 21) and third (n = 3) IV thrombolytic treatments with first IV thrombolytic treatments (n = 21). Also, we compared IV thrombolytic re-treatments ≤3 months from previous IV thrombolysis (n = 10) with those >3 months (n = 14). No significant differences in the rate of intracranial hemorrhage with neurological
deterioration, mortality and restitution of the pre-existing functional status were
observed in the comparative analyses.
Conclusions
IV re-thrombolysis may be safe and effective when recurrent stroke occurs after a
period of complete neurologic regression lasting at least 24 h or minor disability (mRS score ≤2) lasting at least 3 months since the previous stroke.
Keywords
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References
- Time frame and predictors of recovery from disability following recurrent ischemic stroke.Neurology. 2007; 68: 202-205
- Ten-year risk of first recurrent stroke and disability after first-ever stroke in the Perth Community Stroke Study.Stroke. 2004; 35: 731-735
- Repeated thrombolysis for chronologically separated ischemic strokes: a case series.Stroke. 2010; 41: 1829-1832
- Thrombolysis beyond the guidelines: two treatments in one subject within 90 hours based on a modified magnetic resonance imaging brain clock concept.Stroke. 2005; 36: e162-e164
- Adverse outcome of early recurrent ischemic stroke secondary to atrial fibrillation after repeated systemic thrombolysis.Case Rep Vasc Med. 2013; 2013: 371642
- Should repeat thrombolysis be considered after early ischaemic stroke recurrence?.Int J Stroke. 2009; 4: 237-238
- De-novo thrombolysis for recurrent stroke in a patient with prior history of thrombolysis.Blood Coagul Fibrinolysis. 2010; 21: 605-607
- Repeated MR-based intravenous thrombolysis in a patient with short interval stroke recurrences.J Neuroradiol. 2011; 38: 256-258
- Successful repetitive intravenous thrombolysis in a patient with recurrent brainstem infarctions due to megadolichobasilar ectasia.JAMA Neurol. 2013; 70: 520-521
- Repeated thrombolytic therapy in patients with recurrent acute ischemic stroke.J Stroke. 2013; 15: 182-188
- Thrombolysis despite recent stroke: a case series.Stroke. 2013; 44: 1736-1738
- Blood–brain barrier breakdown in acute and chronic cerebrovascular disease.Stroke. 2011; 42: 3323-3328
- Mechanisms of hemorrhagic transformation after tissue plasminogen activator reperfusion therapy for ischemic stroke.Stroke. 2004; 35: 2726-2730
- Pharmacokinetics of alteplase in the treatment of ischaemic stroke.Expert Opin Drug Metab Toxicol. 2012; 8: 271-281
Article info
Publication history
Published online: July 23, 2014
Accepted:
July 16,
2014
Received in revised form:
June 23,
2014
Received:
March 22,
2014
Identification
Copyright
© 2014 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
