Embolic stroke with spontaneous recanalization (P3.085)

Objective To study whether intravenous thrombolysis with alteplase improves clinical outcome in embolic stroke patients who have had spontaneous recanalization. Background None of the randomized controlled trials reported vascular imaging acquired prior to thrombolytic therapy. Effects of thrombolytic drugs in patients with embolic stroke who do not have visible vascular occlusion at presentation remains unknown Design/Methods A retrospective, observational multicenter study was done at eight centers from USA, Europe and India. Medical records of patients who presented during past five years with ischemic stroke and no imaging (CTA/MRA) evidence of vascular occlusion were analyzed. Patients were divided into two groups, one that received thrombolytic therapy and the other that did not. Based on size and location of the infarct on MRI, patients were divided into two subgroups, embolic occlusion with spontaneous recanalization and lacunar stroke. Primary outcome measure was excellent functional outcome defined as modified Rankin Scale < 2 at 3 months. Results Embolic stroke with spontaneous recanalization accounted for a total of 154 patients, 49 in thrombolysis group and 105 in the non thrombolysis group. Logistic regression analysis showed that patients who received thrombolytic therapy had more frequent excellent outcomes with odds ratio of 4.90 (p< 0.01). Symptomatic intra-cerebral hemorrhage was more frequent in thrombolysis group but was not statistically significant (6.1[percnt] vs 1[percnt] p=0.09). Compared to cardioembolic subgroup of NINDS trial and intravenous thrombolysis arm of IMS 3, these patients had better response to thrombolytic therapy. Conclusions This study infers that thrombolysis remarkably improves clinical outcome in patients with embolic stroke who do not have visible arterial occlusion at presentation. A prospective study to validate these results is being planned. Disclosure: Dr. Lahoti has nothing to disclose. Dr. Gokhale has nothing to disclose. Dr. Caplan has received personal compensation in an editorial capacity for JAMA Neurology. Dr. Michel has received personal compensation for activities with Servier, Sanofi-Aventis Pharmaceuticals, and Boehringer Ingelheim Pharmaceuticals, as a speaker, steering committee member, and/or advisory board member. Dr. Samson has nothing to disclose. Dr. Rosso has nothing to disclose. Dr. Limaye has nothing to disclose. Dr. Hinduja has nothing to disclose. Dr. Singhal has received personal compensation for activities as a medicolegal expert witness. Dr. Singhal9s spouse holds stock and/or stock options in Biogen Idec. Dr. Ali has nothing to disclose. Dr. Kryscio has nothing to disclose. Dr. Dedhia has nothing to disclose. Dr. Hastak has nothing to disclose. Dr. Liebeskind has received personal compensation for activities with Stryker and Covidien as a consultant. Dr. Pettigrew has nothing to disclose.