Abstract TMP76: Earlier And Later Recovery After Acute Ischemic Stroke By Immediate Recanalization
Backgrounds: Recanalization in acute ischemic stroke patients is alleged to improve functional outcomes, but its influence on early or late recovery has not been elaborated yet. The aim of this study is to evaluate the association between recanalization within 24 hours after onset and recovery pattern in earlier or later period after stroke.
Methods: From a total of 5602 acute ischemic stroke patients who had admitted to our stroke center over 8-year period, we selected 462 cases documented to have steno-occlusive major arteries and received revascularization treatment. We excluded 122 subjects due to in-hospital mortality, loss of functional outcome information and lack of post-thrombolytic angiography evaluations within 24 hours. Recanalization was blindly and independently evaluated by two authors (BJK and SY) with excellent agreement (κ=0.85). Post-thrombolytic angiography of TICI grade ≥2a and MR or CT angiography of ≤70% stenosis were considered to be recanalized. mRS score at 3 month was collected through structured telephone interview. Early neurological improvement (ENI) was defined to have decreased NIHSS score ≥4-point over hospitalization period, and late recovery was rated using difference of mRS score between at the time of discharge and at 3-month after stroke onset.
Results: Of a total of 340 analyzed cases, 88 (26%) cases were treated with IV thrombolysis, 129 (38%) with IA revascularization, and 123 (36%) with combined IV and IA revascularization. Immediate recanalization within 24 hours occurred in 261 (77%) subjects. ENI was detected in 185 (54%) subjects. Late improvement (mRS score difference ≥1) was documented in 132 (39%) cases, fixed deficit (difference =0) in 145 (43%), late aggravation (difference ≤-1) in 63 (19%), and mortality in 26 (7.6%). After adjusting for relevant covariates, immediate recanalization remained significant with increased odds of having ENI (adjusted OR, 2.51; 95% CI, 1.39 - 4.53) and with decreased odds of having late aggravation (adjusted OR, 0.38; 95% CI, 0.19 - 0.75); but not with late improvement (adjusted OR, 1.50; 95% CI, 0.81 - 2.80).
Conclusion: We documented that beneficial effects from immediate recanalization were associated with earlier improvement and with deterrence of later deterioration.
- © 2012 by American Heart Association, Inc.