Dramatic recovery after IV thrombolysis in anterior circulation ischemic stroke: Predictive factors and prognosis

Abstract

a b s t r a c tBackground and purpose: Dramatic recovery (DR) after thrombolysis is dependent of vessel recanalization and is predictive of favorable clinical outcome. Successful recanalization is not equivalent to DR. Our objective was to assess its frequency and evaluate clinical and biochemical predictors and their prognosis. Methods: We analyzed prospectively registered data from January 2007 to September 2012. All patients with anterior circulation stroke and NIHSS ≥ 10 were included. Improvement of ≥10 or a score ≤3 24 h after thrombolysis was defined as DR. Results: In the 230 patients included, DR frequency was 23% (53 patients). DR group had lower admission NIHSS (14 vs 17, p = 0.024), less total anterior circulation infarcts (p = 0.009), more partial anterior circulation infarcts (p = 0.003) and lower blood glucose on admission (118 vs 128 mg/dL, p = 0.013). All patients with DR had an Alberta Stroke Program Early CT Score (ASPECTS) ≥7, vs 89.3% without DR (p = 0.013). Arterial recanalization, defined as hyperdense middle cerebral artery sign disappearance on control CT, was more frequent in the DR group (68.4% vs 14.1%, p < 0.001). Intracranial hemorrhage on 24 h-control CT scan was less frequent in the DR group (p < 0.001). Multinomial logistic regression analysis showed that ASPECTS score was an independent predictor of DR (OR = 2.35, 95%CI = 1.32-4.16, p = 0.003) and CT evidence of recanalization was independently associated with DR (OR = 11.60, 95%CI, 3.02-44.53, p < 0.001). Conclusion: DR is a frequent occurrence. ASPECTS score is an independent predictor of DR, which is also independently associated with CT evidence of middle cerebral artery recanalization.

Relative CBV ratio on perfusion-weighted MRI indicates the probability of early recanalization after IV t-PA administration for acute ischemic stroke

“…This finding is similar to previous results showing that ER is likely to produce good clinical outcomes after thrombolysis 3 22 29. In particular, SICH did not occur in patients experiencing ER after thrombolysis, which confirmed the concept that ER itself does not potentiate reperfusion injury to damaged brain tissues after thrombolysis 29…”

Predictive Factors for Functional Outcomes After Intravenous Thrombolytic Therapy in Acute Ischemic Stroke

“…Budimkic et al accepted that NIHSS ≤15 is a very good prognosis predictor. 36 -38 In our study, NIHSS scores were statistically higher in our group of patients with poor functional outcomes.…”

National Institutes of Health Stroke Scale Score Less Than 10 at 24 hours After Stroke Onset Is a Strong Predictor of a Favorable Outcome After Mechanical Thrombectomy

“…Clinical factors of ENI for rt-PA and MT therapy include a high ASPECTS, 12 , 15 - 17 short time between onset and treatment, 9 , 12 , 14 , 16 high rate of successful recanalization, 7 , 8 , 10 , 11 , 13 , 15 , 17 effective first-pass recanalization, 28 hemorrhagic transformation, 29 admission high blood pressure, 30 and low prestroke mRS score. 31 In this study, a high ASPECTS, short onset-to-door time, high rate of effective recanalization, few pass times, low prestroke mRS scores, and few symptomatic intracranial hemorrhages after MT were also significantly more common in the favorable outcome group.…”

“…Furthermore, early neurological improvement (ENI) is associated with favorable outcomes 90 days after stroke onset. 7-17 Indices of ENI after MT also reportedly suggest favorable outcomes. 18-20 However, almost all ENI indices as neurological improvement in the acute phase of stroke, but not patient outcome, and ENI indexes are associated with favorable outcomes in patients treated with rt-PA but not MT.…”