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Dramatic Recovery in Acute Ischemic Stroke Is Associated With Arterial Recanalization Grade and Speed.
MedLine Citation:
PMID:  22935403     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: Dramatic recovery (DR) is a predictor of stroke outcome among others. However, after successful recanalization, systematic favorable outcome is not the rule. We sought to analyze the impact of recanalization on DR in patients with acute ischemic stroke eligible for any revascularization strategies (either intravenous or endovascular). METHODS: We analyzed data collected between April 2007 and May 2011 in our prospective clinical registry. All patients with acute ischemic stroke with National Institutes of Health Stroke Scale ≥10 at admission and an identification of arterial status before treatment were included. DR was defined as National Institutes of Health Stroke Scale ≤3 at 24 hours or a decrease of ≥10 points within 24 hours. RESULTS: DR occurred in 75 of 255 patients with acute ischemic stroke (29.4%). Patients with persistent occlusion had a low DR rate (11.1%) than those with no documented occlusion (36.5%) and those with occlusion followed by recanalization (35.3%; both P<0.001). Among patients with recanalization monitored by angiography, DR was higher among patients with complete recanalization than among those with partial recanalization (46.8% versus 14.3%; P<0.001) and increased with tertiles of time to recanalization (P(trend)=0.002). In multivariable logistic regression analysis, grade and time to recanalization appeared independently associated with DR; the adjusted ORs were 4.17 (95% CI, 1.61-10.77) for complete recanalization and 1.24 (95% CI, 1.04-1.48) for each 30-minute time decrease. Patients with versus without DR more frequently had modified Rankin Scale ≤1 (67.6% versus 9.0%; P<0.001) and less frequently had hemorrhage (17.3% versus 33.9%; P=0.024). CONCLUSIONS: DR is strongly associated with favorable clinical outcome and is dependent on complete recanalization and time to recanalization.
Authors:
Mikael Mazighi; Elena Meseguer; Julien Labreuche; Jean-Michel Serfaty; Jean-Pierre Laissy; Philippa C Lavallée; Lucie Cabrejo; Céline Guidoux; Bertrand Lapergue; Isabelle F Klein; Jean-Marc Olivot; Aymeric Rouchaud; Jean-Philippe Desilles; Elisabeth Schouman-Claeys; Pierre Amarenco
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-30
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  -     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-31     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
From the Department of Neurology and Stroke Centre, Bichat University Hospital, Paris, France.
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