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47 Background: Arterial recanalization precedes  clinical improvement in ischemic stroke. However sudden reperfusion may  increase the chance of edema or hemorrhage.Methods: Consecutive patients given intravenous TPA were monitored using  transcranial Doppler (TCD). The NIH Stroke Scale (NIHSS) was performed  before bolus and at 24 hours. Patients with complete or partial  recanalization according to validated criteria were analysed. Duration  of recanalization was classified a priori assudden (abrupt  appearance of a normal or stenotic low resistance signal),stepwise (flow improvement over 1–29 minutes), andslow (30–60 minutes).Results: Recanalization  occurred in 43 patients (age 68±17 years, NIHSS 16.8±6, median 15  points, TPA bolus at 135±61 minutes after onset). Recanalization began  at 23±19 min (median 17) and completed at 42±23 min (median 35) after  bolus. Duration of recanalization was 23±16 min (median 17 min).  Recanalization was sudden in 5, stepwise in 23, and slow in 14  patients. Faster recanalization predicted better short term improvement  (Table, p=0.03). Symptomatic hemorrhage occurred in 1 patient with  stepwise recanalization at 5.5 hours after onset. Slow and/or partial  recanalization with dampened flow signal was found in 53% of patients  with NIHSS ≥ 10 points at 24 hours (p=0.01).Conclusions: Short duration of recanalization is associated  with better short-term improvement mostly likely due to faster clot  break-up and low resistance of the distal circulatory bed. Slow flow  improvement and dampened flow signal are poor prognostic signs that may  be useful in patient selection for interventional  treatment.

Duration of Arterial Recanalization During Intravenous TPA Therapy: Classification and Short-term Improvement