Good clinical outcome after ischemic stroke with successful revascularization is time-dependent

Khatri, Pooja; Abruzzo, Todd; Yeatts, Sharon D.; Nichols, Christopher; Broderick, Joseph P.; Tomsick, Thomas A.

doi:10.1212/wnl.0b013e3181b9c847

Cited by 453 publications

(360 citation statements)

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“…Previous studies found DR in 20-40% of patients with MCA strokes submitted to IV thrombolysis [1][2][3], and we hypothesize the DR frequency we found is in the lower end of this range because we also included patients with ICA occlusions.…”

Section: Discussionmentioning

confidence: 66%

“…Recanalization was one of the first described independent predictors of DR, confirmed by transcranial Doppler (TCD) [1,3], angiography and MR-angiography studies [2,4], but not every patient with successful vessel recanalization after stroke achieves DR or even a good clinical outcome. Early TCD studies showed a trend for DR patients to be treated earlier [1].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have shown higher rates of DR with earlier and more complete recanalization [1,2,4,6], but other factors may have a role. Recognizing these predictive factors could help clinicians to anticipate early response after IV thrombolysis, and also prognosis on longer follow-up, since early improvement benefits are sustained [7], with 67.6% of patients being asymptomatic or minimally symptomatic at 3 months (compared to only 9.0% of patients without DR) [1].…”

Section: Introductionmentioning

confidence: 94%

“…Dramatic recovery (DR), the early and stable clinical improvement after recanalization therapies in the setting of acute ischemic stroke [1], has been reported to occur in 20-40% of patients with middle cerebral artery (MCA) stroke, submitted to intravenous (IV) thrombolysis [1][2][3]. Frequency varies depending on the definition of DR, hindering comparisons.…”

Section: Introductionmentioning

confidence: 99%

“…Different time windows have been defined for improvement to be considered DR, from 1 h [1] to 24 h [2,4] or even 7 days after IV thrombolysis [2]. Additionally, the magnitude of improvement considered as DR varies, from an improvement of ≥40% on NIHSS [5] to the more consensual improvement of ≥10 points on NIHSS or NIHSS < 3 after treatment [1,2,4]. Most of the studies on DR are focused on MCA strokes, and studies analyzing DR after thrombolysis in all anterior circulation strokes, including anterior cerebral and internal carotid (ICA) arteries, are lacking.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

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

Rocha

Pinho

Varanda

et al. 2014

Clinical Neurology and Neurosurgery

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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.

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Section: Discussionmentioning

confidence: 66%