Very Early Neurologic Improvement After Intravenous Thrombolysis

Objective: To evaluate whether very early neurologic improvement (VENI) after intravenous (IV) recombinant tissue plasminogen activator (rt-PA) perfusion in patients with acute ischemic stroke (AIS) predicts favorable outcome at 3 months. Design: Retrospective analysis of prospective data. Setting: Stroke registry at the Stroke Unit, Tenon University Hospital. Patients: We analyzed consecutive patients with AIS treated with IV rt-PA between November 11, 2002, and December 24, 2007. Main Outcome Measures: VENI at 1 hour was defined as a National Institute of Health Stroke Scale score of 0 at the end of rt-PA perfusion or an improvement of 5 or more points compared with baseline. Favorable outcome was defined as a modified Rankin Scale score of 1 or less at 3 months. Results: Of 120 patients with AIS treated with IV rt-PA, 22 (18.3%) had VENI after IV rt-PA perfusion. Favorable outcome was observed in 15 patients with VENI (68.2%) and in 29 patients without VENI (29.6%) (P<.001). No symptomatic intracerebral hemorrhage occurred in patients with VENI. Mortality rates were 0% in the patients with VENI and 17.3% in patients without VENI. Baseline scores for VENI (adjusted odds ratio, 6.23; 95% confidence interval, 2.03-19.13; P=.001) and the National Institute of Health Stroke Scale (0.83; 0.76-0.91; P<.001) were the only 2 factors associated with favorable outcome (modified Rankin Scale score of <= 1). Conclusions: VENI at the end of IV rt-PA perfusion in patients with AIS independently predicts favorable outcome at 3 months.