This Article Full Text Full Text (PDF) All Versions of this Article: 35/1/114    most recent 01.STR.0000110121.57772.18v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Molina, C. A. Search for Related Content PubMed PubMed Citation Articles by Molina, C. A.

(Stroke. 2004;35:114.)
© 2004 American Heart Association, Inc.

Original Contributions

Editorial Comment—Degree of Arterial Recanalization: An End Point For Efficacy in Future Intravenous Thrombolytic Trials

Neurovascular Unit, Vall d’Hebron Hospital, Barcelona, Spain

An extract of the first 250 words of the full text is provided, because this article has no abstract.

From a pathophysiologic viewpoint, acute stroke is, in most cases, the consequence of an arterial occlusion, and the primary mechanism of action of thrombolysis is clot lysis, resulting in recanalization and reestablishment of cerebral blood flow. The National Institutes of Neurological Disorders and Stroke (NINDS) trial¹ clearly demonstrated a beneficial effect of intravenous recombinant tissue plasminogen activator (rtPA) when given <3 hours after symptom onset. However, the NINDS trial, like other clinical trials of intravenous thrombolysis, did not monitor presence and location of arterial occlusion and recanalization at different times after stroke. Criticism of the widespread use of tPA was based on the lack of vascular imaging in the standard emergent evaluation of acute stroke for a rational selection of patients who will obtain more benefit from thrombolysis. In the last few years, however, a tremendous progress and widespread implementation of noninvasive neurovascular techniques including transcranial Doppler (TCD), computed tomography angiography (CTA), and magnetic resonance angiography (MRA) have been achieved. These imaging modalities are being increasingly performed in the acute stroke setting without substantial delay in a large number of centers worldwide. Previous TCD and MRI studies have shown that early recanalization strongly associated with early neurological improvement, reduced infarct size, and favorable prognosis.^2–4 However, the term recanalization involves various grades of success with differential effects on ischemic tissue evolution, clinical course, and outcome.

In the accompanying article, Neumann-Haefelin and colleagues⁵ studied 82 highly selected and homogeneous stroke patients with middle cerebral artery (MCA) main stem occlusions. All patients underwent . . . [Full Text of this Article]