Occlusive Disease and Upright Activity in Acute Ischemic Stroke

Area of Science:

• Neurology
• Rehabilitation Medicine
• Vascular Medicine

Background:

• Early mobilization is crucial for stroke recovery.
• The safety and efficacy of early upright activity in ischemic stroke patients with severe extra- and intracranial stenosis or occlusion remain unclear.

Purpose of the Study:

• To explore the association between severe occlusive cerebrovascular disease and 3-month outcomes in ischemic stroke patients.
• To investigate potential interactions between mobilization treatment (very early mobilization vs. usual care) and occlusive disease on stroke outcomes.

Main Methods:

• Retrospective analysis of ultrasound findings from the A Very Early Rehabilitation Trial (AVERT) cohort.
• Inclusion of ischemic stroke patients with carotid and transcranial Doppler ultrasounds performed within one week of admission.
• Classification of severe stenosis (≥70% extracranial or ≥50% intracranial) or occlusion.

Main Results:

• 19% of patients had severe occlusive disease.
• Patients with occlusive disease showed a trend towards less favorable 3-month outcomes (OR 0.53) and higher mortality (OR 2.52).
• No significant stenosis-by-treatment interaction was observed, though small numbers limited definitive conclusions, particularly for very early mobilization.

Conclusions:

• Severe occlusive cerebrovascular disease may be associated with poorer outcomes after ischemic stroke.
• Current evidence does not support a significant interaction between very early mobilization and occlusive disease on stroke outcomes.
• High-quality prospective studies are required to guide clinical decisions regarding upright activity commencement in acute stroke patients with occlusive disease.