Major neurologic improvement following endovascular recanalization therapy for acute ischemic stroke.
BACKGROUND
We aimed to identify the rate of major neurologic improvement (MNI) at 24 h following endovascular recanalization therapy (ERT) for acute ischemic stroke and its association with short-term outcome.


METHODS
We retrospectively reviewed consecutive acute ischemic stroke patients presenting to our institution over 4 years and undergoing ERT. Angiograms were independently reviewed. Data on demographics, medical history, initial NIHSS score, 24-hour NIHSS score, site of acute vascular lesion, pre- and posttreatment Thrombolysis in Myocardial Infarction scores, symptomatic intracerebral hemorrhage (within 36 h of intervention that was associated with a 4-point decline in NIHSS score) and discharge disposition were collected. We used logistic regression analysis to identify predictors of MNI (defined as >or=8-point improvement in NIHSS or a score of 0-1 at 24 h) and favorable discharge status (defined as home or acute rehabilitation).


RESULTS
Sixty-eight patients were included (median age = 71 years, 60% women, median NIHSS score = 19.5, anterior circulation = 75%). The modes of ERT were pharmacologic only (28%), mechanical only (35%) and multimodal therapy (37%). Thrombolysis in Myocardial Infarction 2 or 3 recanalization was achieved in 64.7% (mechanical only 46%, pharmacologic only 63% and multimodal 84%). The outcomes were: symptomatic intracerebral hemorrhage (11.8%), MNI (26.5%) and favorable discharge (41.2%). Age (OR = 0.93, p = 0.003) and cardioembolic stroke subtype (OR = 6.0, p = 0.018) were independent predictors of MNI. MNI was a strong predictor of favorable discharge status (OR = 46.4, p < 0.001).


CONCLUSIONS
Despite initial stroke severity, MNI occurred in over one fourth of the patients and independently and strongly predicted favorable discharge outcome.
Prabhakaran
Shyam
S
Rush University Medical Center, Chicago, IL 60612, USA. shyam_prabhakaran@rush.edu
Chen
Michael
M
Choi
Jae H
JH
Mangla
Sundeep
S
Lavine
Sean D
SD
Pile-Spellman
John
J
Meyers
Philip M
PM
Chong
Ji Y
JY
D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D002545:Brain Ischemia / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D020767:Intracranial Thrombosis / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome