Abstract Details

Title Predictors of Major Improvement after Intravenous Thrombolysis in Acute Ischemic Stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) IN7 - (-)

Poster/Presentation
Number 010

Objective

Background Intravenous thrombolysis improves outcomes of stroke patients. The immediate response to thrombolysis is variable. There is limited data on predictors of major neurological improvement (MNI) 24 hours following thrombolysis.

Design/Methods We reviewed the prospective database of patients treated through our telestroke network and at our institution between November 2008 and June 2012. We included all patients who received IV t-PA and had 24-hour NIHSS score available. Similar to prior studies, MNI was defined as a reduction in NIHSS score by ?8, or a score of 0 or 1 at 24 hours. We divided patients into two groups based on whether or not they had MNI at 24 hours which were compared for risk factors, time to treatment, clinical and laboratory data. 3-month mRS was determined via telephone; good outcome was defined as mRS ?2. For statistical analysis, we used independent t, and Fisher's exact tests, and performed multivariate logistic regression analysis.

Results Out of 316 patients, 310 had 24-hour NIHSS scores; 38% of them experienced MNI. Patients with MNI were less likely to be older than 80 years (16% vs. 29%, p=0.008) and have atrial fibrillation (9% vs. 24%, p=0.001). Risk factors, blood glucose, blood pressure, and NIHSS score were similar between both groups. On multivariate analysis, independent predictors of MNI were age <80 years (OR=1.9,CI: 1.1-3.6,p=0.03) and absence of atrial fibrillation (OR=3.0,CI: 1.4-6.2,p=0.004). Patients exhibiting MNI fared better at 3 months (83% vs. 40%, p<0.001) with lower mortality (23% vs. 7%, p<0.001).

Conclusions Younger patients without atrial fibrillation more likely exhibited MNI 24 hours following thrombolysis. MNI could serve as an early marker of thrombolytic activity and outcome after stroke which may be used in clinical trials. It may also help select patients for early endovascular treatment after intravenous thrombolysis.

Authors/Disclosures
Nicolas A. Bianchi, MD (Emory University) PRESENTER	Dr. Bianchi has received personal compensation in the range of $0-$499 for serving as a Consultant for Innovation Hub Enterprises, LLC. The institution of Dr. Bianchi has received research support from Emory Medical Care Foundation.
Archana Hinduja, MD	Dr. Hinduja has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Shadi Yaghi, MD	Dr. Yaghi has nothing to disclose.
	No disclosure on file

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