Very early neurologic improvement after intravenous thrombolysis.
OBJECTIVE
To evaluate whether very early neurologic improvement (VENI) after intravenous (i.v.) recombinant tissue plasminogen activator (rt-PA) perfusion in patients with acute ischemic stroke (AIS) predicts favorable outcome at 3 months.


METHODS
Retrospective analysis of prospective data.


METHODS
Stroke registry at the Stroke Unit, Tenon University Hospital.


METHODS
We analyzed consecutive patients with AIS treated with i.v. rt-PA between November 11, 2002, and December 24, 2007.


METHODS
VENI at 1 hour was defined as a National Institute of Health Stroke Scale score of 0 at the end of rt-PA perfusion or an improvement of 5 or more points compared with baseline. Favorable outcome was defined as a modified Rankin Scale score of 1 or less at 3 months.


RESULTS
Of 120 patients with AIS treated with i.v. rt-PA, 22 (18.3%) had VENI after i.v. rt-PA perfusion. Favorable outcome was observed in 15 patients with VENI (68.2%) and in 29 patients without VENI (29.6%) (P < .001). No symptomatic intracerebral hemorrhage occurred in patients with VENI. Mortality rates were 0% in the patients with VENI and 17.3% in patients without VENI. Baseline scores for VENI (adjusted odds ratio, 6.23; 95% confidence interval, 2.03-19.13; P = .001) and the National Institute of Health Stroke Scale (0.83; 0.76-0.91; P < .001) were the only 2 factors associated with favorable outcome (modified Rankin Scale score of ≤1).


CONCLUSIONS
VENI at the end of i.v. rt-PA perfusion in patients with AIS independently predicts favorable outcome at 3 months.
Department of Neurology (Stroke Unit), Assistance Publique—Hôpitaux de Paris, Tenon University Hospital, Paris, France.
Ioan-Paul
IP
Muresan
Pascal
P
Favrole
Pierre
P
Levy
Frederic
F
Andreux
Béatrice
B
Marro
Sonia
S
Alamowitch
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000628:therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D020127:Recovery of Function; D012042:Registries; D018709:Statistics, Nonparametric; D020521:Stroke / Q000628:therapy*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator