Clinical Improvement at 24 Hours after MCA Occlusion Can be Predicted From the End of TPA Infusion NIH Stroke Scale Score

Document Type


Publication Date



Stroke assessment, Thrombolysis


BACKGROUND: Recanalization precedes clinical improvement in patients treated with IV TPA. Transcranial Doppler (TCD) can assess the timing and degree of recanalization. We studied how the degree of recanalization and the NIH stroke scale (NIHSS) at the end of infusion correlated with short-term clinical improvement at 24 hours. Subjects and Methods: We evaluated consecutive IV TPA treated patients with anterior circulation ischemic symptoms, TCD evidence of occlusion, and serial NIHSS assessments (baseline, end of infusion, 24 hours post infusion). TCD was interpreted at the end of infusion using validated criteria for degree of recanalization. Changes in the NIHSS were defined as improvement (≥4 point improvement or complete resolution)or deterioration(decline of ≥2). Results: 52 patients met the criteria for inclusion (baseline NIHSS 17±6, median 18, range 5–29). By the end of infusion, NIHSS scores improved in 26 patients (50%). From the end of infusion to 24 hours, subsequent improvement by ≥4 points occurred in another 9 patients (17%), mostly in patients with partial recanalization (56%). NIHSS at end infusion correlated with NIHSS at 24 hrs in all patients (Adjusted R2=0.74). In patients with no recanalization, end-of-infusion NIHSS most highly predicted 24 hour scores (Adj.R2=.89) while correlation was less significant with partial(Adj.R2=.61) and complete(Adj.R2=.66) recanalization(all p

Digital Object Identifier (DOI)


Citation / Publisher Attribution

Stroke, v. 32, issue suppl. 1