Dramatic recovery after IV thrombolysis in anterior circulation ischemic stroke: Predictive factors and prognosis

Background and purpose Dramatic recovery (DR) after thrombolysis is dependent of vessel recanalization and is predictive of favorable clinical outcome. Successful recanalization is not equivalent to DR. Our objective was to assess its frequency and evaluate clinical and biochemical predictors and their prognosis. Methods We analyzed prospectively registered data from January 2007 to September 2012. All patients with anterior circulation stroke and NIHSS ≥ 10 were included. Improvement of ≥10 or a score ≤3 24 h after thrombolysis was defined as DR. Results In the 230 patients included, DR frequency was 23% (53 patients). DR group had lower admission NIHSS (14 vs 17, p = 0.024), less total anterior circulation infarcts (p = 0.009), more partial anterior circulation infarcts (p = 0.003) and lower blood glucose on admission (118 vs 128 mg/dL, p = 0.013). All patients with DR had an Alberta Stroke Program Early CT Score (ASPECTS) ≥7, vs 89.3% without DR (p = 0.013). Arterial recanalization, defined as hyperdense middle cerebral artery sign disappearance on control CT, was more frequent in the DR group (68.4% vs 14.1%, p < 0.001). Intracranial hemorrhage on 24 h-control CT scan was less frequent in the DR group (p < 0.001). Multinomial logistic regression analysis showed that ASPECTS score was an independent predictor of DR (OR = 2.35, 95%CI = 1.32–4.16, p = 0.003) and CT evidence of recanalization was independently associated with DR (OR = 11.60, 95%CI, 3.02–44.53, p < 0.001). Conclusion DR is a frequent occurrence. ASPECTS score is an independent predictor of DR, which is also independently associated with CT evidence of middle cerebral artery recanalization.