Repeated intravenous thrombolysis after recurrent stroke. A case series and review of the literature

Background: The likelihood of severe disability and death increases with each recurrent stroke. Repeated intravenous (IV) thrombolysis remains one of the therapeutic options when secondary prevention fails; however, its effects after recurrent stroke are largely unknown. The aim of the present review was to assess the risks and benefits of IV re-thrombolysis after recurrent stroke as compared with IV thrombolysis after index stroke. Methods: We identified 8 patients who repeated IV thrombolysis after recurrent stroke from among the 615 consecutive stroke patients who received IV thrombolysis at our Stroke Unit and 22 cases of IV re-thrombolysed patients extracted for the literature review of case reports and case series. Results: After excluding the 6 patients treated with endovascular procedures, we included in the analyses 21 patients for which we had data on pre-stroke functional status and baseline neurological severity for each stroke event and post-treatment functional status for each IV thrombolysis. We compared second (n = 21) and third (n = 3) IV thrombolytic treatments with first IV thrombolytic treatments (n = 21). Also, we compared IV thrombolytic re-treatments <= 3 months from previous IV thrombolysis (n = 10) with those >3 months (n = 14). No significant differences in the rate of intracranial hemorrhage with neurological deterioration, mortality and restitution of the pre-existing functional status were observed in the comparative analyses. Conclusions: IV re-thrombolysis may be safe and effective when recurrent stroke occurs after a period of complete neurologic regression lasting at least 24 h or minor disability (mRS score <= 2) lasting at least 3 months since the previous stroke. (C) 2014 Elsevier B.V. All rights reserved.