{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T07:32:57Z","timestamp":1785396777794,"version":"3.56.0"},"reference-count":39,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["SVIN"],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Recanalization of cerebral large\u2010vessel occlusions (LVOs) by intravenous thrombolysis is infrequent but has been relatively unexplored with ultraearly treatment. We evaluated prehospital treatment with tissue plasminogen activator (tPA) in a mobile stroke unit to explore the recanalization rate in patients with LVOs and its effect on early clinical improvement and long\u2010term disability.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods<\/jats:title>\n            <jats:p xml:lang=\"en\">Prospectively collected data were analyzed from Houston mobile stroke unit patients who were treated with tPA and had LVOs identified by either hyperdense arteries on computed tomography or arterial occlusion on computed tomography angiography while on board the mobile stroke unit. The primary outcome was immediate recanalization (IRC), categorized as resolution of LVO on repeat vascular imaging in the emergency department (ED) or on emergent angiography. The secondary outcome was change in National Institutes of Health Stroke Scale from baseline and modified Rankin score at 90 days.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Sixty\u2010nine patients with anterior or posterior circulation LVOs were enrolled; the median time from last known normal to tPA bolus was 64.0 minutes (interquartile range, 52.0\u201389.0). Nineteen patients (28%) had IRC, with 11 based on computed tomography angiography on ED arrival and 8 based on first run of emergent angiography. Median time from tPA bolus to documentation of IRC was 61.0 minutes (interquartile range, 42.0\u2013111.0). IRC was associated with improvement in median National Institutes of Health Stroke Scale from baseline (17.0 [14.0\u201322.0]) to ED arrival (10.0 [5.5\u201316.5]) and to 24 hours (4.0 [0.5\u201310.5]). Of the non\u2010IRC patients, 41 had recanalization after endovascular thrombectomy and 9 did not receive recanalization. The IRC group, earlier last known normal to tPA bolus, greater baseline National Institutes of Health Stroke Scale, and M1 and M2 middle cerebral artery occlusion locations were independently associated with greater improvement in National Institutes of Health Stroke Scale from baseline to ED arrival. The 90\u2010day modified Rankin score distribution was best in the IRC group, followed by the delayed recanalization group, and both had significantly less disability than the no recanalization group (\n              <jats:italic>P<\/jats:italic>\n              =0.002).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Recanalization by ED arrival occured in 28% of patients with LVO who received tPA treatment in a mobile stroke unit and results in early clinical improvement and less disability at 90 days.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/svin.121.000101","type":"journal-article","created":{"date-parts":[[2022,3,8]],"date-time":"2022-03-08T16:28:39Z","timestamp":1646756919000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Immediate Recanalization of Large\u2010Vessel Occlusions by Tissue Plasminogen Activator Occurs in 28% of Patients Treated in a Mobile Stroke Unit"],"prefix":"10.1161","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9151-6015","authenticated-orcid":false,"given":"Alexandra L.","family":"Czap","sequence":"first","affiliation":[{"name":"Department of Neurology McGovern Medical School at the University of Texas Health Science Center at Houston TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Parker","sequence":"additional","affiliation":[{"name":"Department of Neurology McGovern Medical School at the University of Texas Health Science Center at Houston TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose\u2010Miguel","family":"Yamal","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Data Science School of Public Health at the University of Texas Health Science Center at Houston TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengxi","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Data Science School of Public Health at the University of Texas Health Science Center at Houston TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noopur","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Data Science School of Public Health at the University of Texas Health Science Center at Houston TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinhao","family":"Zou","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Data Science School of Public Health at the University of Texas Health Science Center at Houston TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenny","family":"Phan","sequence":"additional","affiliation":[{"name":"Department of Neurology McGovern Medical School at the University of Texas Health Science Center at Houston TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suja S.","family":"Rajan","sequence":"additional","affiliation":[{"name":"Department of Management Policy and Community Health School of Public Health at the University of Texas Health Science Center at Houston TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James C.","family":"Grotta","sequence":"additional","affiliation":[{"name":"Mobile Stroke Unit and Stroke Research Clinical Innovation and Research Institute at the Memorial Hermann Hospital TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ritvij","family":"Bowry","sequence":"additional","affiliation":[{"name":"Department of Neurology McGovern Medical School at the University of Texas Health Science Center at Houston TX"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2016-012830"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2015-012231"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2016.5374"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.117.017208"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.118.021579"},{"key":"e_1_3_2_7_2","unstructured":"Roos Y on behalf of the MR CLEAN\u2010NO IV investigators . Intravenous thrombolysis followed by endovascular thrombectomy versus direct endovascular thrombectomy: a randomized controlled trial. Paper presented at: International Stroke Conference 2021; March 18 2021. Accessed October 5 2021. https:\/\/professional.heart.org\/\u2010\/media\/phd\u2010files\/meetings\/isc\/2021\/science\/news\/isc21_mrclean_noiv_summary_slide.pdf?la=en."},{"key":"e_1_3_2_8_2","first-page":"3","article-title":"Solitaire with the intention for thrombectomy plus intravenous t\u2010PA versus DIRECT solitaire stent\u2010retriever thrombectomy in acute anterior circulation stroke. Paper presented at: European Stroke Organization Conference 2021; September 1, 2021","volume":"6","author":"Fischer U","year":"2021","unstructured":"Fischer U, Gralla J, on behalf of the SWIFT\u2010DIRECT investigators . Solitaire with the intention for thrombectomy plus intravenous t\u2010PA versus DIRECT solitaire stent\u2010retriever thrombectomy in acute anterior circulation stroke. 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Treatment with tissue plasminogen activator in the golden hour and the shape of the 4.5\u2010hour time\u2010benefit curve in the National United States Get With The Guidelines \u2013 Stroke Population. Circulation. 2017;135:128\u2013139.","journal-title":"Circulation"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.031591"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(17)30008-X"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.119.028626"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.115.011093"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1111\/jon.12276"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.2850"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(12)70057-1"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1177\/1747493017711950"},{"key":"e_1_3_2_32_2","first-page":"E344","article-title":"Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association\/American Stroke Association","volume":"50","author":"Powers WJ","year":"2020","unstructured":"Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, et\u00a0al. 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