Abstract WP107: Early Recurrence of Ischemic Stroke in Alteplase-treated Patients: The ENCHANTED Study

Abstract

Introduction: Early recurrence of acute ischemic stroke (AIS) predicts adverse outcome, but there is uncertainty about the predictors after intravenous alteplase. We aimed to determine the predictors of stroke/transient ischemic attack (TIA) and their prognostic significance among ENCHANTED participants. Methods: ENCHANTED was an international, randomized, open-label, blinded-endpoint trial of low- versus standard-dose intravenous alteplase in AIS patients. Log-rank test and multivariable analysis with cox-regression models were used to assess the association of baseline characteristics and stroke/TIA recurrence and of functional outcome (modified Rankin scale [mRS] scores 2-6) at 90 days. Results: Among 3297 AIS participants, 103 (3%) had early recurrent AIS/TIA, which was predicted by recruitment in South America (hazard ratio 1.75, 95%CI 1.04-2.94), history of coronary artery disease (1.67, 1.03-2.72) and extra/intra-cranial vessel stenosis (2.94, 1.49-5.81), premorbid mRS ≥1 (1.63, 1.04-2.55), lipid lowering therapy (1.66, 1.03-2.67), multiple ischemic brain imaging lesions (2.33, 1.50-3.61), and cardioembolic stroke (1.58, 1.02-2.46). Early recurrence was independently associated with poor functional outcome (odds ratio 4.76, 95%CI 2.63-8.42). Conclusions: After treatment with intravenous alteplase, early recurrence of cerebral ischemic events complicates recovery and residual disability. Better targeting of preventive strategies in those at high risk, specifically those with cardioatherosclerosis and cardioembolic disease, may improve outcome from AIS.