Published Online
on February 8, 2007

A more recent version of this article appeared on March 1, 2007

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Submitted on August 23, 2006
Revised on October 2, 2006
Accepted on October 17, 2006

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; and 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.

^* To whom correspondence should be addressed. 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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