title: Dramatic recovery in acute ischemic stroke is associated with arterial recanalization grade and speed.
abstract: OBJECTIVE
  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 (Ptrend=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.affiliation: Department of Neurology and Stroke Centre, Bichat University Hospital, INSERM U-698, Paris-Diderot University, 46, rue Henri Huchard, 75018 Paris, France. mikael.mazighi@bch.aphp.fr
authors.forename: Mikael
authors.initials: M
authors.lastname: Mazighi
authors.forename: Elena
authors.initials: E
authors.lastname: Meseguer
authors.forename: Julien
authors.initials: J
authors.lastname: Labreuche
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Serfaty
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Laissy
authors.forename: Philippa C
authors.initials: PC
authors.lastname: Lavallée
authors.forename: Lucie
authors.initials: L
authors.lastname: Cabrejo
authors.forename: Céline
authors.initials: C
authors.lastname: Guidoux
authors.forename: Bertrand
authors.initials: B
authors.lastname: Lapergue
authors.forename: Isabelle F
authors.initials: IF
authors.lastname: Klein
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Olivot
authors.forename: Aymeric
authors.initials: A
authors.lastname: Rouchaud
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Desilles
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Schouman-Claeys
authors.forename: Pierre
authors.initials: P
authors.lastname: Amarenco
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000473:pathology / Q000628:therapy*; D002548:Cerebral Revascularization; D005260:Female; D006801:Humans; D008297:Male; D020127:Recovery of Function; D020521:Stroke / Q000473:pathology / Q000628:therapy*; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome