SAN FRANCISCO — One in four consecutive acute ischemic stroke patients displayed immediate improvement within a day of receiving intra-arterial thrombolytic treatment, the investigator of a retrospective 108-patient study reported at the 32nd International Stroke Conference.
Faster time to treatment, greater reperfusion, and good pial collateral formation distinguished the 26 patients (24.5%) who displayed the “Lazarus phenomenon” from those who did not make rapid recoveries, according to a poster presented by Dr. Gregory A. Christoforidis and his colleagues.
“Some people improve even on the table after you dissolve the clot,” Dr. Christoforidis, an interventional radiologist at Ohio State University, Columbus, said Feb. 8 at the meeting, which was sponsored by the American Stroke Association. This improved condition disrupted the procedure in some cases, he said, as they started to move limbs that had been immobilized.
All patients in the study underwent intra-arterial thrombolytic treatment within 6 hours of symptom onset. The investigators defined the “Lazarus phenomenon” as a decrease in the National Institutes of Health Stroke scale (NIHSS) score by at least 50% within the first 24 hours after treatment.
The 49 women and 59 men in the study presented with a median NIHSS score of 16. Lazarus phenomenon patients improved a median of 10 points during the first 24 hours.
Although intra-arterial treatment has a longer time window than the 0- to 3-hour standard for intravenous treatment with clot-busting drugs, time to treatment was one of three significant factors favoring the Lazarus phenomenon in a multivariate analysis. Most patients in the study were treated between 3 and 6 hours after onset of symptoms. Those who recovered rapidly were treated within 198 minutes on average vs. 299 minutes for the others.
Nearly all the Lazarus phenomenon patients (92.3%) had good pial collateral formation vs. 59.7% of the other patients. The investigators scored pial collaterals on the basis of angiography. They said the study suggests that patients with a large ischemic penumbra, as evidenced by greater pial collateral formation, are most likely to benefit from reperfusion.
Nearly half the patients with 50% or greater reperfusion experienced the Lazarus phenomenon. It was not seen in any patients with poor reperfusion and poor pial collateral formation.
None of the other factors studied—systolic blood pressure, admitting glucose levels, admitting platelet levels, site of occlusion thrombolytic agent, and age—was significant in predicting rapid recovery.
Nearly half the patients with 50% or greater reperfusion experienced rapid recovery. DR. CHRISTOFORIDIS