E-ISSN 1309-4866
Research Article
Factors Associated with Early Recovery after Intravenous Thrombolytic Therapy in Acute Ischemic Stroke
1 Eskişehir Osmangazi Üniversitesi Tıp Fakültesi, Nöroloji Anabilim Dalı, Eskişehir, Türkiye  
Arch Neuropsychiatry ; : -
DOI: 10.5152/npa.2017.22664
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Key Words: Acute stroke, rt-PA, thrombolysis, outcome, recovery
Abstract

Introduction: We aimed to identify the factors associated with early neurological improvement (ENI) in acute stroke patients treated with intravenous recombinant tissue plasminogen activator (IV rt-PA) and to determine the association between ENI and outcomes at 3 months after stroke.

 

Methods: Patients with acute ischemic stroke who were treated with IV rt-PA within 4,5 hours of symptom onset from February 2009 to December 2016 were included in the study at the stroke center of XXX University Medical Faculty. ENI was defined as an improvement in National Institutes of Health Stroke Scale (NIHSS) score of ≥ 8 points compared to the pretreatment score or an NIHSS score of 0 or 1 at 24 hours after stroke. We assessed the outcomes at 3 months after treatment using the modified Rankin Scale (mRS) score and mRS scores of 0–1 were defined as  ‘very good ’ outcome.

 

Results: ENI was observed in 43.9 % of 355 patients included in the study. Very good outcome at 3 months was detected in 80.1% of the patients with ENI and in 15.6% of the patients without ENI (p<0.001). Patients with ENI were younger (p = 0.025) and had lower NIHSS scores (p=0.027) and higher ASPECT scores (p = 0.008) than those without. The ENI group had lower serum glucose levels at the time of admission (p < 0.001). Additionally, the presence of diabetes mellitus, hypertension and hyperdense artery sign were more frequent in the ENI group (p = 0.001, p = 0.024 and p <0.001, respectively). Finally, multiple regression analysis showed a significant relationship between serum glucose level, hyperdense artery sign, and ENI.

 

Conclusion: There is a significant relationship between ENI and very good outcome at 3 months in acute stroke patients who received IV rt-PA. Therefore, management of factors such as serum glucose level, NIHSS score, ASPECT score and presence of hyperdense artery sign which are related to ENI and determination of treatment strategies according to them are important for achieving a better outcome in acute ischemic stroke.

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