Kharitonova et al. conducted a study to evaluate the association of restoration of blood flow and early neurologic improvement (NI) after inyravenous thrombolysis (IVT) on 3-month outcome. This is an important question because many stroke centers are adopting protocols that use recanalization status after IVT to identify patients for rescue reperfusion intervention.

Patients in this retrospective study were enrolled in the Safe Implementation of Treatment in Stroke International Stroke Thrombolysis Register (SITS-ISTR). All 5324 patients had documented baseline vessel occlusion and follow-up vessel imaging 22-36h after IVT. Patients with NI and vessel recanalization were more likely to be independent at 3 months than patients with  persistent occlusion despite NI and and those without NI despite recanalization (OR 15.9; 95% CI 12.5-20.0 vs. OR 4.7; 95% CI 3.6-6.1 and OR 2.7; 95% CI 2.2 -3.3, respectively).

In short, recanalization of an occluded artery in an acute stroke setting was associated with favorable functional outcome regardless of rapid NI after IVT. This concludes that recanalization with rescue therapy should be considered in patients with persisting occlusion after thrombolysis even after significant neurological improvement.