Published Online
on July 10, 2006

A more recent version of this article appeared on July 18, 2006

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Submitted on October 25, 2005
Revised on April 28, 2006
Accepted on May 1, 2006

Early Recurrent Ischemic Stroke in Stroke Patients Undergoing Intravenous Thrombolysis

Dimitrios Georgiadis MD^*, Stefan Engelter MD, Barbara Tettenborn MD, Hansjörg Hungerbühler MD, Regina Luethy MD, Felix Müller MD, Marcel Arnold MD, Christian Giambarba MD, Christian Rainer Baumann MD, Hans-Christian von Büdingen MD, Philipp Lyrer MD, and Ralf Werner Baumgartner MD

From the Departments of Neurology, Universities of Zürich (D.G., C.R.B., H.-C.v.B., R.W.B.) and of Basel (S.E., P.L.); the Departments of Neurology, District Hospitals of St Gallen (B.T.) and of Aarau (H.H., C.B.); the Department of Internal Medicine (R.L.), District Hospital of Triemli; the Department of Neurology (F.M.), District Hospital of Thurgau (Münsterlingen); the Department of Neurology (M.A.), University of Bern; and the Department of Internal Medicine (C.G.), District Hospital of Waid, Switzerland.

^* To whom correspondence should be addressed. E-mail: Dimitrios.Georgiadis{at}usz.ch.

Background--We assessed the incidence of early recurrent ischemic stroke in stroke patients treated with intravenous tissue-type plasminogen activator (tPA) and the temporal pattern of its occurrence compared with symptomatic intracranial hemorrhage (ICH).

Methods and Results--Prospectively collected, population-based data for 341 consecutive acute stroke patients (62% men; mean age, 66 years) treated with tPA according to the National Institute of Neurological Disorders and Stroke study protocol at 8 medical centers in Switzerland (3 academic and 5 community) between January 2001 and November 2004 were retrospectively analyzed. The primary outcome measure was neurological deterioration 4 points on the National Institutes of Health Stroke Scale occurring within 24 hours of tPA treatment and caused either by recurrent ischemic stroke (defined as the occurrence of new neurological symptoms suggesting involvement of initially unaffected vascular territories and evidence of corresponding ischemic lesions on cranial computed tomography scans, in the absence of ICH) or by ICH. Early recurrent ischemic stroke was diagnosed in 2 patients (0.59%; 95% confidence interval, 0.07% to 2.10%) and symptomatic ICH in 15 patients (4.40%; 95% confidence interval, 2.48% to 7.15%). Both recurrent ischemic strokes occurred during thrombolysis, whereas symptomatic ICHs occurred 2 to 22 hours after termination of tPA infusion.

Conclusions--Recurrent ischemic stroke is a rare cause of early neurological deterioration in acute stroke patients undergoing intravenous thrombolysis, with a different temporal pattern compared with that of symptomatic ICH.

Key words: cerebral infarction • cerebral ischemia • cerebrovascular disorders • stroke • thrombolysis

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