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Association of growth factors with arterial recanalization and clinical outcome in patients with ischemic stroke treated with tPA
Author(s) -
SOBRINO T.,
MILLÁN M.,
CASTELLANOS M.,
BLANCO M.,
BREA D.,
DORADO L.,
RODRÍGUEZGONZÁLEZ R.,
RODRÍGUEZYÁÑEZ M.,
SERENA J.,
LEIRA R.,
DÁVALOS A.,
CASTILLO J.
Publication year - 2010
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/j.1538-7836.2010.03897.x
Subject(s) - ischemic stroke , medicine , cardiology , stroke (engine) , outcome (game theory) , ischemia , mechanical engineering , engineering , mathematics , mathematical economics
Summary. Background: Growth factors (GF) such as vascular endothelial growth factor (VEGF), angiopoietin‐1 (Ang‐1) and granulocyte‐colony stimulating factor (G‐CSF) have been associated with greater efficacy of tissue plasminogen activator (tPA) in experimental studies. Objectives: To study the association of these GF with arterial recanalization and clinical outcome in patients with acute ischemic stroke treated with tPA. Methods: We prospectively studied 79 patients with ischemic stroke attributable to MCA occlusion treated with i.v. tPA within the first 3 h from onset of symptoms. Continuous transcranial color‐coded sonography (TCCS) was performed during the first 2 h after tPA bolus to assess early MCA recanalization. Hemorrhagic transformation (HT) was classified according to ECASS II definitions. Good functional outcome was defined as a Rankin scale score of 0–2 at 90 days. GF levels were determined by ELISA. Results: Mean serum levels of VEGF, G‐CSF and Ang‐1 at baseline were significantly higher in patients with early MCA recanalization ( n = 30) (all P < 0.0001). In the multivariate analysis, serum levels of VEGF (OR, 1.03), G‐CSF (OR, 1.02) and Ang‐1 (OR, 1.07) were independently associated with early MCA recanalization (all P < 0.0001). On the other hand, patients with parenchymal hematoma (PH) ( n = 20) showed higher levels of Ang‐1 ( P < 0.0001). Ang‐1 (OR, 1.12; P < 0.0001) was independently associated with PH, whereas patients with good outcome ( n = 38) had higher levels of G‐CSF ( P < 0.0001). G‐CSF was independently associated with good outcome (OR, 1.12; P = 0.036). Conclusions: These findings suggest that GF may enhance arterial recanalization in patients with ischemic stroke treated with t‐PA, although they might increase the HT.