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Ioan-Paul Muresan, MD; Pascal Favrole, MD; Pierre Levy, MD; Frederic Andreux, MD; Béatrice Marro, MD; Sonia Alamowitch, MD

Arch Neurol. 2010;67(11):1323-1328. doi:10.1001/archneurol.2010.265

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.

Author Affiliations: Departments of Neurology (Stroke Unit) (Drs Muresan, Favrole, Andreux, and Alamowitch), Public Health (Dr Levy), and Radiology (Dr Marro), Assistance Publique—Hôpitaux de Paris, Tenon University Hospital, Department of Neurology, Pierre and Marie Curie University (Dr Alamowitch), and INSERM Unite Mixte de Recherche S 707 4 Paris, France.

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