Arterial Recanalization in the Golden Hour of IV tPA Administration for Ischemic Stroke (S47.003)

OBJECTIVE: IV tPA given within the first hour of symptom onset increases recanalization rates in LVO. BACKGROUND: Intracranial large vessel occlusions (LVO) are responsible for approximately 45[percnt] of ischemic strokes and the cause of detrimental ischemic strokes associated with poor outcome and high mortality. Little data exist about rates of LVO recanalization with ultra-early administration of IV tPA. METHODS: Retrospective chart review of all patients who received tPA and were subsequently treated in our health system in 2014. We identified patients that had occlusion of internal carotid artery (ICA) , M1 middle cerebral artery (MCA), A1 segment anterior cerebral artery (ACA), or basilar artery on CTA, MRA, or angiography and compared recanalization rates within 6 hours after administration of IV tPA between those that received tPA ultra-early (≤ 1 hour after symptom onset) versus those that received tPA beyond 1 hour. RESULTS: In 2014, 168 patients received IV tPA of which 35 had LVO. Of these, 9 patients received tPA within 1 hour of symptom onset (group 1) while the remaining 26 patients were treated after one hour (group 2). Both groups did not differ in regards to age, gender, initial NIHSS, and occluded vessel. Significant differences were found in recanalization rate and mortality between both groups. Recanalization of the LVO after tPA was found in four of nine patients (44[percnt]) in group 1 compared to 3 of 26 patients (12[percnt]) in group 2 (P < 0.043). All patient in group 1 survived (0[percnt] mortality) beyond the hospitalization while six of 16 patients died in group 2 (23[percnt] mortality, p < 0.046). CONCLUSIONS: Ultra-early IV tPA administration within the golden hour appears to have higher LVO recanalization rates as compared to later treatment. Further studies of reperfusion rates in ultra-early thrombolysis are warranted. Disclosure: Dr. Bernatowicz has nothing to disclose. Dr. Donohue has nothing to disclose. Dr. Hussain has nothing to disclose. Dr. John has nothing to disclose. Dr. Wisco has nothing to disclose. Dr. Uchino has nothing to disclose.