rtPA intravenous thrombolysis in anterior choroidal artery territory stroke

Objective: To study the possible specific response to recombinant tissue pl asminogen activator (rtPA) thrombolysis of anterior choroidal artery (AChA) stroke. Background: Outcome and response after rtPA thrombolysis are possi bly better in small-vessel infarcts, but a specific study of AChA stroke ha s not yet been performed. Methods: The authors proposed an open trial of TV rtPA within 7 hours in patients age 20 and 81 years with all types of inte rnal carotid artery territory stroke if the baseline Scandinavian Stroke Sc ale (SSS) score was less than 48. A dose of rtPA 0.8 mg/kg was infused over 90 minutes, Of 114 consecutive patients, 9 patients (7.9%) exhibited hypod ensity in the AChA territory on day 1 brain CT. Results: Seven of nine pati ents with AChA infarct had a primary early recovery within 6 hours after th e initiation of rtPA infusion, In addition, recovery was complete in five p atients and partial in two patients. No intracerebral hematoma was observed , Three patients had a "reinfarct syndrome" at 12, 25, and 48 hours respect ively. However, in the two latter patients treated with IV heparin, the def icit disappeared again with the increase of heparin dose in one patient and disappeared spontaneously in the other patient. The overall outcome at day 90 was six total recoveries in nine patients (66%). Patients with a final good outcome had a slight "unstructured" hypodensity in the AChA territory on day 1 brain CT, whereas patients with a bad outcome had the classic "str uctured" hypodensity of AChA territory stroke. Conclusion: These data suppo rt a specific quick response of AChA territory stroke to IV rtPA thrombolys is, probably due to the small size of the artery and of the "clot." The hig h frequency of the reinfarct syndrome is a clinical fact that is difficult to explain. Efficient heparin treatment after 24 hours may control the rein farct syndrome in some patients.