on January 25, 2007
Published online before print January 25, 2007, doi: 10.1161/01.STR.0000257314.74853.2b
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Submitted on August 22, 2006
From the Neurosonology and Stroke Research Program (G.T., V.K.S., A.Y.L., A.V.A.), Barrow Neurological Institute, Phoenix, Arizona; the Department of Neurology (G.T.), University of Athens School of Medicine, Athens, Greece; the Department of Medicine (Neurology) (M.S.), University of Alberta, Canada; the Division of Neurology, Department of Medicine (V.K.S.), National University Hospital, Singapore; the University of Santo Tomas (A.Y.L.), Manila, Philippines; and the Department of Clinical Neuroscience (M.D.H.), University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada. * To whom correspondence should be addressed. E-mail: tsivgoulisgiorg{at}yahoo.gr.
Background and Purpose--Elevated systolic blood pressure (SBP) and lack of early vessel recanalization are predictors of poor outcome among patients with stroke treated with systemic tissue plasminogen activator (tPA). We aimed to evaluate the potential relationship between pretreatment SBP and tPA-induced recanalization. Methods--Consecutive patients with acute ischemic stroke resulting from intracranial artery occlusion were treated with standard intravenous tPA and assessed with 2-MHz transcranial Doppler for arterial recanalization. Early arterial recanalization was determined with previously validated Thrombolysis in Brain Ischemia flow grading system at 120 minutes after tPA bolus. Functional outcome at 3 months was evaluated using the modified Rankin Scale. Results--A total of 351 patients received intravenous tPA (mean age: 68.7±13.4 years, median National Institutes of Health Stroke Scale score 16.5). Patients with complete recanalization (n=94) had lower mean pretreatment SBP values (152±23 mm Hg) than patients with incomplete or absent recanalization (n=257, 160±22 mm Hg, P=0.010). Pretreatment SBP levels were inversely associated with complete recanalization (OR per 10-mm Hg increase: 0.85; 95% CI: 0.74 to 0.98, P=0.022) after adjustment for demographics, risk factors, stroke severity, pretreatment Thrombolysis in Brain Ischemia grades, and continuous versus intermittent exposure to transcranial Doppler. Although patients with poor functional 3-month outcomes (modified Rankin Scale >2) had higher pretreatment SBP values (160±25 mm Hg) than functionally independent patients (154±20 mm Hg, P=0.027), pretreatment SBP levels were not independently associated with functional outcome on multivariable analysis. Age, complete recanalization, baseline National Institutes of Health Stroke Scale score, and time from symptom onset to tPA bolus were independent (P<0.05) predictors of 3-month outcome. Conclusion--Higher pretreatment SBP levels are associated with poor recanalization in patients with acute stroke treated with intravenous tPA.
Revised on September 25, 2006
Accepted on October 3, 2006
Association of Pretreatment Blood Pressure With Tissue Plasminogen Activator-Induced Arterial Recanalization in Acute Ischemic Stroke
Georgios Tsivgoulis MD*;
Key words: blood pressure • outcome • recanalization • stroke • thrombolysis
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