Failure of complete recanalization is associated with poor outcome after cardioembolic stroke
Article first published online: 11 FEB 2011
© 2011 The Author(s). European Journal of Neurology © 2011 EFNS
European Journal of Neurology
Volume 18, Issue 9, pages 1171–1178, September 2011
How to Cite
Nam, H. S., Lee, K.-Y., Kim, Y. D., Choi, H.-Y., Cho, H.-J., Cha, M.-J., Nam, C. M. and Heo, J. H. (2011), Failure of complete recanalization is associated with poor outcome after cardioembolic stroke. European Journal of Neurology, 18: 1171–1178. doi: 10.1111/j.1468-1331.2011.03360.x
- Issue published online: 11 AUG 2011
- Article first published online: 11 FEB 2011
- Received 1 October 2010 Accepted 5 January 2011
- cardiac embolism;
- cerebral infarction;
- thrombolytic therapy
Background: Recanalization is strongly associated with outcomes after thrombolytic treatment. Cardiac emboli are known as better response to fibrinolytic agents because they are fibrin-rich; however, cardioembolic stroke itself is associated with poor outcomes and high mortality. Completeness of recanalization may therefore affect the outcome of cardioembolic stroke. We investigated whether degree of recanalization influences outcomes following fibrinolytic therapy in cardioembolic stroke.
Methods: Consecutive stroke patients with relevant artery occlusions on baseline CT angiography who had received thrombolytic treatment were enrolled. Completeness of recanalization was assessed by the Thrombolysis in Myocardial Infarction (TIMI) grade, which was compared between patients with and without cardiac sources of embolism (CSE). We also investigated independent predictors of poor outcome (modified Rankin scale score 3–6) at 3 months.
Results: Of the 127 patients enrolled, 65 (51%) had one or more CSE. Although the overall recanalization rates (TIMI 2 or 3) in patients with CSE (65%) and patients without CSE (68%) were similar (P = 0.710), patients with CSE were less likely to show complete recanalization (TIMI 3) compared with those without CSE (19% vs. 39%, P = 0.011). Multivariate analysis revealed that CSE was associated with failure of complete recanalization (OR 2.809, 95% CI 1.097–7.192) and was an independent predictor of poor outcome at 3 months (OR 3.629, 95% CI 1.205–8.869).
Conclusions: In cardioembolic strokes, failure of complete recanalization following thrombolytic therapy was frequent and was associated with poor outcome after thrombolysis.