title: Correlation between the Occlusion Site and Clinical Outcome after Acute Ischemic Stroke.
abstract: OBJECTIVE
  The significance of early mild clinical improvement after intravenous tissue plasminogen activator (IVtPA) treatment is unclear. Therefore, we examined whether the timing of clinical improvement after IVtPA predicted the clinical outcome at 3 months.
  
  
  METHODS
  Consecutive patients with acute cerebral infarction in the anterior circulation who received IVtPA treatment within 3 hours of the onset of symptoms were enrolled in the study. Patients were classified according to the timing of clinical improvement [early responder (ER), National Institutes of Health Stroke Scale (NIHSS) score improved ≥4 points or who had a score of 0 within 2 hours after IVtPA; late responder (LR), a similar improvement between 2 and 24 hours; and non-responder (NR)] and according to the arterial occlusion site (P group, internal carotid artery and proximal middle cerebral artery M1 region; and D group, distal M1 and M2).
  
  
  RESULTS
  Ninety-three patients [median age, 74 (67-79) years; 54 men (58%); median NIHSS score, 11 (7-16)] were enrolled in the study. The P group consisted of 48 (52%) patients and the D group consisted of 45 (48%) patients. Thirty-eight patients (41%) were classified as ERs, 20 (22%) as LRs, and 35 (38%) as NRs. On a multivariate regression analysis, the P group [odds ratio (OR), 3.24; 95% confidence interval (CI), 1.08-10.45; p=0.036] and NR (OR, 4.04; 95% CI, 1.29-14.27; p=0.016) were independent predictors of a poor outcome. ER (47%, p=0.01) and LR (45%, p=0.01) patients showed fewer poor outcomes than NR (77%) patients, but the rate did not differ significantly between the ER and LR patients.
  
  
  CONCLUSIONS
  Early mild clinical recovery did not predict a good outcome. The occlusion site was a stronger predictor of clinical improvement after IVtPA administration.
authors.affiliation: Department of Neurological Science, Nippon Medical School, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Suzuki
authors.forename: Junya
authors.initials: J
authors.lastname: Aoki
authors.forename: Takao
authors.initials: T
authors.lastname: Kanzawa
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Nishiyama
authors.forename: Yohei
authors.initials: Y
authors.lastname: Takayama
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kimura
authors.forename: Satoshi
authors.initials: S
authors.lastname: Takahashi
authors.forename: Tadashige
authors.initials: T
authors.lastname: Kano
authors.forename: Kazunori
authors.initials: K
authors.lastname: Akaji
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Tanizaki
authors.forename: Kazumi
authors.initials: K
authors.lastname: Kimura
authors.forename: Ban
authors.initials: B
authors.lastname: Mihara
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000187:drug effects*; D002533:Cerebral Angiography; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging; D016017:Odds Ratio; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator