title: Predictive factors for early clinical improvement after intra-arterial thrombolytic therapy in acute ischemic stroke.
abstract: BACKGROUND
  In acute ischemic stroke, the speed of improvement after intra-arterial thrombolytic therapy (IAT)-mediated recanalization varies. This study aimed to identify clinical and radiological variables that are predictive of early improvement (EI) after IAT in acute ischemic stroke.
  
  
  METHODS
  This single-center retrospective cohort study included 141 consecutive patients who underwent IAT for terminal internal carotid and/or middle cerebral artery (MCA) occlusions. EI was defined as a National Institutes of Health Stroke Scale (NIHSS) score less than 3 or NIHSS score improvement of 8 points or more within 72 hours of IAT. The EI and non-EI groups were compared in terms of clinical and radiological findings before and after IAT.
  
  
  RESULTS
  Forty-nine patients showed EI (34.8%). Multivariate analysis revealed that atrial fibrillation (odds ratio [OR] .35, 95% confidence interval [CI] .14-.89, P = .028) and hyperdense MCA sign (OR .39, CI .15-.97, P = .042) were related with lack of EI. The independent EI predictors were less extensive parenchymal lesion on baseline computed tomography (OR 4.92, CI 1.74-13.9, P = .003), intermediate to good collaterals (OR 3.28, CI 1.16-9.31, P = .026), and recanalization within 6 hours of symptom onset (OR 5.2, CI 1.81-14.94, P = .002). EI associated with favorable outcomes (modified Rankin scale score 0-2) at discharge (88% versus 7%; P < .001) and 3 months after discharge (92% versus 18%; P < .001).
  
  
  CONCLUSIONS
  The clinical and radiological variables maybe useful for predicting EI and favorable long-term outcomes after IAT.
authors: Daejeon-Chungnam Regional Cerebrovascular Center, Hospital and School of Medicine, Chungnam National University, Daejeon, South Korea; Department of Neurology, Hospital and School of Medicine, Chungnam National University, Daejeon, South Korea.
authors: Hye Seon
authors: HS
authors: Jeong
authors: Daejeon-Chungnam Regional Cerebrovascular Center, Hospital and School of Medicine, Chungnam National University, Daejeon, South Korea; Department of Neurology, Hospital and School of Medicine, Chungnam National University, Daejeon, South Korea.
authors: Hyun-Jo
authors: HJ
authors: Kwon
authors: Daejeon-Chungnam Regional Cerebrovascular Center, Hospital and School of Medicine, Chungnam National University, Daejeon, South Korea; Department of Neurosurgery, Hospital and School of Medicine, Chungnam National University, Daejeon, South Korea.
authors: Chang Woo
authors: CW
authors: Kang
authors: Daejeon-Chungnam Regional Cerebrovascular Center, Hospital and School of Medicine, Chungnam National University, Daejeon, South Korea; Department of Neurosurgery, Hospital and School of Medicine, Chungnam National University, Daejeon, South Korea.
authors: Hee-Jung
authors: HJ
authors: Song
authors: Daejeon-Chungnam Regional Cerebrovascular Center, Hospital and School of Medicine, Chungnam National University, Daejeon, South Korea; Department of Neurosurgery, Hospital and School of Medicine, Chungnam National University, Daejeon, South Korea.
authors: Hyeon Song
authors: HS
authors: Koh
authors: Daejeon-Chungnam Regional Cerebrovascular Center, Hospital and School of Medicine, Chungnam National University, Daejeon, South Korea; Department of Neurology, Hospital and School of Medicine, Chungnam National University, Daejeon, South Korea.
authors: Sang Min
authors: SM
authors: Park
authors: Daejeon-Chungnam Regional Cerebrovascular Center, Hospital and School of Medicine, Chungnam National University, Daejeon, South Korea; Department of Neurology, Hospital and School of Medicine, Chungnam National University, Daejeon, South Korea.
authors: Jung Geol
authors: JG
authors: Lim
authors: Department of Information and Statistics, College of Natural Science, Chungnam National University, Daejeon, South Korea.
authors: Ji Eun
authors: JE
authors: Shin
authors: Department of Information and Statistics, College of Natural Science, Chungnam National University, Daejeon, South Korea.
authors: Suk Hoon
authors: SH
authors: Lee
authors: Daejeon-Chungnam Regional Cerebrovascular Center, Hospital and School of Medicine, Chungnam National University, Daejeon, South Korea; Department of Neurology, Hospital and School of Medicine, Chungnam National University, Daejeon, South Korea. Electronic address: jeikim@cnu.ac.kr.
authors: Jei
authors: J
authors: Kim
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications; D002545:Brain Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015331:Cohort Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000473:pathology; D007269:Injections, Intra-Arterial; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011859:Radiography; D020127:Recovery of Function; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Acute ischemic stroke; early improvement; intra-arterial thrombolysis; predicting factors