Early dramatic recovery after successful endovascular reperfusion for acute cerebral major artery occlusion

Abstract

Background and purpose: Timings of symptom improvement of acute ischemic stroke patients who obtained successful endovascular reperfusion with subsequent favorable outcome at 90 days are not uniform. The purpose of this study was to clarify factors related to early symptom improvement after successful endovascular reperfusion. Methods: Among consecutive stroke patients treated using endovascular therapy at our institute between April 2012 and March 2016, we retrospectively reviewed those who obtained successful (Thrombolysis In Cerebral Infarction grade ≥2b) with subsequent favorable outcome defined as a modified Rankin Scale score of 0–2 at 90 days. Early dramatic recovery (EDR) was defined as an improvement of ≥10 points in National Institutes of Health Stroke Scale (NIHSS) score or a total score of 0–3 at 24 h after onset compared with the pretreatment score. Results: A total of 53 patients (mean age, 70.3±12.1 years; 17 females; median pretreatment NIHSS score, 15; interquartile range (IQR), 11–21) were included. The leading cause of stroke was cardioembolism (36 patients) and 30 patients received intravenous thrombolysis. EDR occurred in 45 patients (85%). Patients with EDR had lower white blood cell counts (7826.7±2827.7 vs. 10,137.5±3112.2/μl, p=0.03; adjusted odds ratio (OR), 0.99; 95% confidence interval (CI), 0.99–1.00) and lower blood urea nitrogen (BUN)/serum creatinine (Cre) ratio (18.1±6.0 vs. 24.7±8.1, p=0.02; adjusted OR, 0.81; 95%CI, 0.65–0.94) compared with those without EDR. In addition, patients with EDR showed better 90-day clinical outcome (median modified Rankin Scale score, 1 (IQR, 0–2) vs. 2 (IQR, 1–2), p=0.03) than those without. Conclusions: Lower BUN/Cre ratio was associated with EDR in acute stroke patients who obtained successful endovascular reperfusion with subsequent favorable outcome at 90 days.