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VENI predicted 3-month improvement after IV administration of recombinant tissue plasminogen activator
Muresan I. Arch Neurol. 2010;67:1323-1328.
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Very early neurologic improvement at the end of intravenous recombinant tissue plasminogen activator perfusion among patients with acute ischemic stroke independently predicted favorable outcomes at 3 months, new data from the Archives of Neurology suggested.
Researchers from Paris analyzed 124 consecutive patients from a stroke registry who had acute ischemic stroke and were treated with IV recombinant tissue plasminogen activator between 2002 and 2007. They defined a favorable outcome by a modified Rankin Scale score of 1 or less at the 3-month follow-up.
Data obtained from 120 patients indicated that 22 (18.3%) had very early neurologic improvement (VENI). At 24 hours, symptomatic intracerebral hemorrhages occurred in five patients (4.2%), with all cases documented in patients without VENI (P=.58). Researchers reported favorable outcomes in 15 patients with VENI (68.2%) and 29 patients without VENI (29.6%; P<.001).
The overall mortality rate at 3 months was 14.1%; 17.3% in patients without VENI and 0% in patients with VENI (P=.07). The only factors associated with favorable outcomes, according to the results, were baseline scores for VENI (adjusted OR=6.23; 95% CI, 2.03-19.13) and the NIH Stroke Scale (NIHSS; adjusted OR=0.83; 95% CI, 0.76-0.91).
“Our results suggest that VENI, as determined by a clinical routine tool (NIHSS) at a patient’s bedside, might help to rapidly select patients who will not respond to IV [recombinant tissue plasminogen activator] but who could be candidates for bridging therapy,” the researchers wrote. “The value of this dynamic clinical factor alone and in combination with the rate of recanalization by transcranial Doppler needs to be confirmed in a large prospective study of patients undergoing IV thrombolysis.”
In an accompanying editorial, José Biller, MD, with the department of neurology, Loyola University Chicago, said future research is necessary to better understand the clinical utility of these findings.
“It would be interesting to know in future studies the specific sites of arterial occlusion as well as the Trial of ORG 10172 in Acute Stroke Treatment [TOAST] classification of strokes in both patients with VENI and those without,” Biller said.
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