Outcome of ischemic stroke patients with serious post-thrombolysis neurological deficits

Strbian D, Atula S, Meretoja A, Kaste M, Tatlisumak T, for the Helsinki Stroke Thrombolysis Registry Group. Outcome of ischemic stroke patients with serious post-thrombolysis neurological deficits. Acta Neurol Scand: 2013: 127: 221-226. c 2012 John Wiley & Sons A/S. Objectives To identify factors associated with favorable outcome in ischemic stroke patients having considerable post-thrombolytic neurological deficits but without endovascular treatment. Materials and methods We registered 1427 consecutive thrombolysis-treated ischemic stroke patients, of which 473 (33%) had 8 NIH Stroke Scale (NIHSS) points after thrombolysis but did not undergo any further rescue intervention. We dichotomized them based on 3-month modified Rankin Scale (mRS) to those with favorable (mRS 02, n=126, 27%) and unfavorable (mRS 36, n=347) outcome. Univariate and multivariable methods tested associations of baseline and post-thrombolysis parameters with outcome. Results Lower post-thrombolysis NIHSS score and younger age had strongest association with favorable outcome. Most of patients with post-thrombolytic NIHSS score 11 achieved unfavorable outcome. In contrast, half of patients with favorable outcome had post-thrombolytic NIHSS10, and 62% of patients younger than 75years and having post-thrombolytic NIHSS 89 achieved favorable outcome. Weaker independent association was observed for blood glucose level and baseline diastolic blood pressure. Conclusions As expected, NIHSS score and patient age showed the strongest association with final outcome in a subpopulation of patients having considerable post-thrombolytic neurological deficit. A relatively high proportion of patients with post-thrombolytic NIHSS 89 (10) achieved a favorable 3-month outcome without any further intervention.