Predictors of clinical outcome in patients receiving local intra-arterial thrombolysis without subsequent symptomatic intracranial hemorrhage against acute middle cerebral artery occlusion.

BACKGROUND AND
PURPOSE: The factors that predict favorable outcome after local intra-arterial thrombolysis (LIT) remain unknown. We aimed to clarify these factors in patients with middle cerebral artery occlusion treated by LIT.
METHODS: We performed LIT in 26 consecutive patients who had middle cerebral artery occlusion with a modified Rankin scale (mRS) score <or=2 before stroke onset. We assessed background characteristics, angiographic findings, and mRS score at discharge. We compared these factors between patients with good outcome (mRS score, <or=2) and those with poor outcome (mRS score, >or=3).
RESULTS: The duration from symptom onset to hospital admission was 0.96 +/- 0.87 (mean +/- SD) hour and from onset of stroke to LIT was 3.78 +/- 1.17 hours. No patients developed symptomatic intracerebral hemorrhage or died. Thirteen patients achieved good outcomes. No significant differences existed between the two groups in baseline National Institutes of Health Stroke Scale (NIHSS) scores, time from stroke onset to LIT, blood pressure, early CT signs, or subsequent hemorrhagic transformation shown by CT. However, univariate analysis showed that patients with good outcomes were younger, more often had absence of hypertension history, had better collaterals shown by angiography, and had better recanalization rates than those with poor outcomes. NIHSS scores after LIT were lower in patients with good outcomes than in patients with poor outcomes. Logistic regression analysis indicated improvement of the NIHSS scores by >or=2 immediately after LIT was independently associated with good outcome.
CONCLUSION: Improvement of the NIHSS score by >or=2 immediately after LIT is a useful predictor of patient outcome at discharge.