Muresan Ioan-Paul, Favrole Pascal, Levy Pierre, Andreux Frederic, Marro Béatrice, Alamowitch Sonia
Department of Neurology (Stroke Unit), Assistance Publique—Hôpitaux de Paris, Tenon University Hospital, Paris, France.
Arch Neurol. 2010 Nov;67(11):1323-8. doi: 10.1001/archneurol.2010.265.
To evaluate whether very early neurologic improvement (VENI) after intravenous (i.v.) recombinant tissue plasminogen activator (rt-PA) perfusion in patients with acute ischemic stroke (AIS) predicts favorable outcome at 3 months.
Retrospective analysis of prospective data.
Stroke registry at the Stroke Unit, Tenon University Hospital.
We analyzed consecutive patients with AIS treated with i.v. rt-PA between November 11, 2002, and December 24, 2007.
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.
Of 120 patients with AIS treated with i.v. rt-PA, 22 (18.3%) had VENI after i.v. 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).
VENI at the end of i.v. rt-PA perfusion in patients with AIS independently predicts favorable outcome at 3 months.
评估急性缺血性卒中（AIS）患者静脉注射重组组织型纤溶酶原激活剂（rt-PA）灌注后极早期神经功能改善（VENI）是否可预测3个月时的良好预后。
对前瞻性数据进行回顾性分析。
特农大学医院卒中单元的卒中登记处。
我们分析了2002年11月11日至2007年12月24日期间接受静脉rt-PA治疗的连续性AIS患者。
1小时时的VENI定义为rt-PA灌注结束时美国国立卫生研究院卒中量表评分为0，或较基线改善5分及以上。良好预后定义为3个月时改良Rankin量表评分为1或更低。
在120例接受静脉rt-PA治疗的AIS患者中，22例（18.3%）在静脉rt-PA灌注后出现VENI。15例有VENI的患者（68.2%）和29例无VENI的患者（29.6%）观察到良好预后（P<0.001）。有VENI的患者未发生症状性脑出血。有VENI的患者死亡率为0%，无VENI的患者死亡率为17.3%。VENI的基线评分（调整优势比，6.23；95%置信区间，2.03-19.13；P=0.001）和美国国立卫生研究院卒中量表（0.83；0.76-0.91；P<0.001）是与良好预后（改良Rankin量表评分≤1）相关的仅有的两个因素。
AIS患者静脉rt-PA灌注结束时的VENI可独立预测3个月时的良好预后。
