Introduction: Intracranial large vessel occlusions (LVO) are responsible for approximately 45% 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.
Hypothesis: IV tPA given within the first, so called "golden hour", of symptom onset increases recanalization rates in LVO.
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 patient received IV tPA of which 35 had LVO. Of these, 9 patients received tPA within one hour of symptom onset while the remaining 26 patients were treated after one hour. Both groups did not differ in regards to age, gender, initial NIHSS, and occluded vessel.
Table 1 summarizes the results.
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 LVO strokes with ultra-early thrombolysis are warranted.