Abstract 2332: Prestroke Physical Activity And Functional Recovery In Patients With Ischemic Stroke And Arterial Occlusion (africa Study)

Abstract

Objective: AFRICA study aims 1) to investigate the association between prestroke physical activity (PhA) and short-term functional outcome in patients with an acute anterior territory arterial occlusion and 2) to study its relationship with long-term functional recovery and biological signatures of neurorepair. This analysis focuses on the first objective. Methods: Prestroke PhA was measured with the international physical activity (IPQ), METS and PASE questionnaires in patients with an acute middle cerebral artery (MCA) or terminal intracranial carotid artery (TICA) occlusion of less than 8 hours duration detected by transcranial Duplex. Primary variable was good functional outcome at 3 months (Rankin scale ≤ 2). Secondary variables were hemorrhagic transformation (HT) at 24-36h, infarct volume at day 30 and early recanalization in patients treated with i.v. tPA (TIBI 4 o 5 within 2h after bolus). Results: We studied 159 consecutive patients. Mean age was 68 and median NIHSS 17); 96 patients were treated with i.v. tPA and 55 with mechanical thrombectomy, in 28 cases after failed i.v. tPA and in 27 cases as a first choice, whereas 36 patients did not receive reperfusion therapies. The 3 PhA scales were highly correlated (coeff. >0.97), so we selected IPQ for our purpose. Compared to patients with low level (group A, n=69) and medium level (group B, n=45) of PhA, patients with high level of PhA (group C, n=45) were younger, (median age 76/72/65 for A/B/C), showed lower systolic BP, stroke severity (median NIHSS, 20/14/11), and frequency of TICA occlusion (35%/2%/4%) (all p<0.001). Intravenous tPA was given in 29%/53.3%/53.3% (p 0.032), whereas mechanical thrombectomy alone (17%/16%/18%) or in combination with i.v. tPA (19%/16%/18%) was comparable. The higher the level of PhA the higher the rate of good functional outcome (4%/69%/89%) and early recanalization after i.v. tPA (0%/35%/62%), and the smaller the volume of infarction (107/9/5 cc) (all p<0,001). No differences were found in the rate of HT. Adjusted OR of good outcome was 170 [18-1591] for group C and 62 [8-455] for group B compared to the reference group (A) after adjusting for age, NIHSS score, serum glucose, systolic BP and postprocedural (i.v or i.a) recanalization. Conclusion: Prestroke PhA is associated with better short-term functional outcome and higher rate of recanalization after i.v. tPA in patients with acute ischemic stroke. These effects are robust, but a confounding bias cannot be ruled out due to imbalances in some prognostic baseline variables.