BACKGROUND: Major neurologic improvement at 24 hours after administration of recombinant tissue plasminogen activator (rt-PA) in acute stroke may predict good outcome at 3 months. OBJECTIVE: To identify predictors of major neurologic improvement at 24 hours after IV rt-PA administration and its relationship with outcome at 3 months. METHODS: The authors analyzed patients with acute stroke treated with IV rt-PA from two academic centers in London, Ontario, and 33 affiliated hospitals between 1999 and 2003. Major neurologic improvement was defined by a > or = 8-point improvement in NIH Stroke Scale (NIHSS) score or an NIHSS score of 0 or 1 at 24 hours. Good outcome was defined as a 3-month modified Rankin Scale of 0 to 1. RESULTS: Of 219 patients with acute stroke treated with rt-PA, 61 (28%) had major neurologic improvement at 24 hours. Glucose levels < 8 mmol/L (OR 4.98, 95% CI 1.6 to 15.2), lack of cortical involvement on 24 hour CT scan (OR 3.97, 95% CI 1.87 to 8.43), and female sex (OR 2.4, 95% CI 1.12 to 5.13) were associated with major neurologic improvement after adjusting for covariates. Patients with major neurologic improvement had a shorter hospital stay (6.7 vs 14.3 days; p = 0.001). Major neurologic improvement was an independent predictor of good outcome at 3 months (OR 12.8, 95% CI 4.72 to 34.6). CONCLUSIONS: Major neurologic improvement after rt-PA was observed in 28% of patients and independently predicted good outcome at 3 months. Female sex, glucose levels < 8 mmol/L, and absence of cortical involvement at 24 hours CT scan were associated with major neurologic improvement.
BACKGROUND: Major neurologic improvement at 24 hours after administration of recombinant tissue plasminogen activator (rt-PA) in acute stroke may predict good outcome at 3 months. OBJECTIVE: To identify predictors of major neurologic improvement at 24 hours after IV rt-PA administration and its relationship with outcome at 3 months. METHODS: The authors analyzed patients with acute stroke treated with IV rt-PA from two academic centers in London, Ontario, and 33 affiliated hospitals between 1999 and 2003. Major neurologic improvement was defined by a > or = 8-point improvement in NIH Stroke Scale (NIHSS) score or an NIHSS score of 0 or 1 at 24 hours. Good outcome was defined as a 3-month modified Rankin Scale of 0 to 1. RESULTS: Of 219 patients with acute stroke treated with rt-PA, 61 (28%) had major neurologic improvement at 24 hours. Glucose levels < 8 mmol/L (OR 4.98, 95% CI 1.6 to 15.2), lack of cortical involvement on 24 hour CT scan (OR 3.97, 95% CI 1.87 to 8.43), and female sex (OR 2.4, 95% CI 1.12 to 5.13) were associated with major neurologic improvement after adjusting for covariates. Patients with major neurologic improvement had a shorter hospital stay (6.7 vs 14.3 days; p = 0.001). Major neurologic improvement was an independent predictor of good outcome at 3 months (OR 12.8, 95% CI 4.72 to 34.6). CONCLUSIONS: Major neurologic improvement after rt-PA was observed in 28% of patients and independently predicted good outcome at 3 months. Female sex, glucose levels < 8 mmol/L, and absence of cortical involvement at 24 hours CT scan were associated with major neurologic improvement.
Authors: Jeremy J Heit; Michael Mlynash; Stephanie M Kemp; Maarten G Lansberg; Soren Christensen; Michael P Marks; Santiago Ortega-Gutierrez; Gregory W Albers Journal: Stroke Date: 2019-05 Impact factor: 7.914
Authors: Manuel Cappellari; Paolo Bovi; Giuseppe Moretto; Andrea Zini; Patrizia Nencini; Maria Sessa; Mauro Furlan; Alessandro Pezzini; Giovanni Orlandi; Maurizio Paciaroni; Tiziana Tassinari; Gaetano Procaccianti; Vincenzo Di Lazzaro; Luigi Bettoni; Carlo Gandolfo; Giorgio Silvestrelli; Maurizia Rasura; Giuseppe Martini; Maurizio Melis; Maria Vittoria Calloni; Fabio Chiodo-Grandi; Simone Beretta; Maria Guarino; Maria Concetta Altavista; Simona Marcheselli; Giampiero Galletti; Laura Adobbati; Massimo Del Sette; Armando Mancini; Daniele Orrico; Serena Monaco; Anna Cavallini; Rossella Sciolla; Francesco Federico; Umberto Scoditti; Fabio Brusaferri; Claudio Grassa; Luigi Specchio; Maria Roberta Bongioanni; Marco Sparaco; Mauro Zampolini; Gabriele Greco; Rinaldo Colombo; Bruno Passarella; Alessandro Adami; Domenico Consoli; Danilo Toni Journal: Neurology Date: 2013-01-23 Impact factor: 9.910
Authors: R I Aviv; J Mandelcorn; S Chakraborty; D Gladstone; S Malham; G Tomlinson; A J Fox; S Symons Journal: AJNR Am J Neuroradiol Date: 2007-10-05 Impact factor: 3.825