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(Stroke. 2007;38:955.)
© 2007 American Heart Association, Inc.

Original Contributions

Speed of tPA-Induced Clot Lysis Predicts DWI Lesion Evolution in Acute Stroke

Raquel Delgado-Mederos, MD; Alex Rovira, MD; José Alvarez-Sabín, MD, PhD; Marc Ribó, MD; Josep Munuera, MD; Marta Rubiera, MD; Esteban Santamarina, MD; Olga Maisterra, MD; Pilar Delgado, MD; Joan Montaner, MD, PhD Carlos A. Molina, MD, PhD

From the Department of Neurology (R.D.-M., J.A.-S., M.R., M.R., E.S., O.M., P.D., J. Montaner, C.A.M.) and the Magnetic Resonance Unit (A.R., J. Munuera), Hospital Universitari Vall d’Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.

Correspondence to Carlos A. Molina, MD, PhD, Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d’ Hebron, Universitat Autonoma de Barcelona, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain. E-mail cmolina{at}vhebron.net

Background and Purpose— We sought to evaluate the impact of the speed of recanalization on the evolution of diffusion- weighted imaging (DWI) lesions and outcome in stroke patients treated with tissue-type plasminogen activator (tPA).

Methods— We evaluated 113 consecutive stroke patients with a middle cerebral artery occlusion who were treated with intravenous tPA. All patients underwent multiparametric magnetic resonance imaging studies, including DWI and perfusion-weighted imaging before and 36 to 48 hours after administration of a tPA bolus. Patients were continuously monitored with transcranial Doppler during the first 2 hours after tPA administration. The pattern of recanalization on transcranial Doppler was defined as sudden (<1 minute), stepwise (1 to 29 minutes), or slow (>30 minutes).

Results— During transcranial Doppler monitoring, 13 (12.3%) patients recanalized suddenly, 32 (30.2%) recanalized in a stepwise manner, and 18 (17%) recanalized slowly. Baseline clinical and imaging parameters were similar among recanalization subgroups. At 36 to 48 hours, DWI lesion growth was significantly (P=0.001) smaller after sudden (3.23±10.5 cm³) compared with stepwise (24.9±37 cm³), slow (46.3±38 cm³), and no (51.7±34 cm³) recanalization. The slow pattern was associated with greater DWI growth (P=0.003), lesser degree of clinical improvement (P=0.021), worse 3-month outcome (P=0.032), and higher mortality (P=0.003).

Conclusions— The speed of tPA-induced clot lysis predicts DWI lesion evolution and clinical outcome. Unlike sudden and stepwise patterns, slow recanalization is associated with greater DWI lesion growth and poorer short- and long-term outcomes.

Key Words: reperfusion • stroke • transcranial Doppler • treatment • ultrasound

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