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Simple clinical predictors of stroke outcome based on National Institutes of Health Stroke Scale score during 1‐h recombinant tissue‐type plasminogen activator infusion
Author(s) -
Osaki M.,
Miyashita F.,
Koga M.,
Fukuda M.,
Shigehatake Y.,
Nagatsuka K.,
Minematsu K.,
Toyoda K.
Publication year - 2014
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.12294
Subject(s) - medicine , modified rankin scale , thrombolysis , tissue plasminogen activator , cutoff , stroke (engine) , intracerebral hemorrhage , cardiology , ischemic stroke , ischemia , subarachnoid hemorrhage , mechanical engineering , physics , quantum mechanics , myocardial infarction , engineering
Background and purpose An index for predictors of stroke outcome was determined based on the National Institutes of Health Stroke Scale ( NIHSS ) scores during 1‐h intravenous administration of recombinant tissue‐type plasminogen activator (rt‐ PA ). Methods Stroke patients with baseline NIHSS score ≥8 and occlusion at the internal carotid or middle cerebral arteries ( ICA , MCA ) were retrospectively studied from a prospective single‐center registry. NIHSS scores and inverse change from baseline scores (Δ NIHSS ) were assessed at 30 min and 1 h after rt‐ PA infusion. Patients were divided into two groups according to arterial occlusion sites: group P, ICA or proximal M1; and group D, distal M1 or M2. A modified Rankin Scale score of 2–6 at 3 months was defined as an unfavorable outcome. Results In all 108 patients, the cutoff NIHSS score predicting unfavorable outcome was ≥12 and cutoff Δ NIHSS scores were ≤2 at both 30 min and 1 h. In group P ( n = 36), the cutoff NIHSS score was ≥14 at both 30 min and 1 h and cutoff Δ NIHSS scores were ≤1 at 30 min and ≤2 at 1 h. Unfavorable outcome was seen in all patients with NIHSS 1 h ≥ 14, Δ NIHSS 30 min ≤ 1 and Δ NIHSS 1 h ≤ 2. In group D ( n = 72), the cutoff NIHSS scores were ≥12 at both 30 min and 1 h, and cutoff Δ NIHSS scores were ≤2 at 30 min and ≤7 at 1 h; 90% of patients with unfavorable outcome showed Δ NIHSS 1 h ≤ 7. Conclusion NIHSS and Δ NIHSS during 1‐h rt‐ PA infusion seemed predictive of 3‐month outcome when the site of arterial occlusion was identified prior to rt‐ PA .