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From the Stroke Unit (G.J.H.), Royal Perth Hospital, Perth, and School of Medicine and Pharmacology (G.J.H.), University of Western Australia, Crawley, Australia; and sanofi-aventis recherche and développement (J.S., Z.H., P.C., S.G.), Bagneux, France
Address correspondence and reprint requests to Dr Hankey, Stroke Unit, Department of Neurology, Royal Perth Hospital, 197 Wellington St., Perth, Australia, 6000; e-mail: gjhankey{at}cyllene.uwa.edu.au
Objective: To assess the rate, degree, and predictors of recovery from a disabled to nondisabled state in patients disabled after recurrent ischemic stroke.
Methods: Patients with ischemic stroke enrolled in the Management of Atherothrombosis with Clopidogrel in High Risk Patients (MATCH) Study underwent prospective assessment of their modified Rankin score (mRS) at 1, 3, 6, 12, and 18 months after enrollment and after recurrent stroke. Patients disabled (defined as mRS 
3) after recurrence were analyzed for recovery (defined as mRS < 3) during the 18 months, and predictors of recovery were sought using a Cox proportional-hazard multiple regression analysis.
Results: Three hundred forty-five (54%) of 637 patients were disabled after recurrent ischemic stroke; 115 (33%) patients had been disabled and 230 (66%) nondisabled before stroke recurrence. At recurrence, the degree of disability was moderate (mRS 3) in 135 (39%) patients, severe (mRS 4) in 139 (40%), and very severe (mRS 5) in 71 (21%). After 12 months' median follow-up, 117 (34%, 95% CI: 29 to 39%) had recovered: 68 (50%, 42 to 59%) of 135 moderately disabled, 45 (32%, 25 to 41%) of 139 severely disabled, and 4 (6%, 2 to 14%) of 71 very severely disabled; 70 (20.3%) patients died. From recurrence, median time to recovery was 6 months (mRS 3) and 18 months (mRS 4); 94% with very severe disability had not recovered at 18 months. Independent predictors of recovery were moderate disability at recurrence (mRS 3) compared with severe (mRS 4: hazard ratio [HR] 1.5; 95% CI 1.04 to 2.3) or very severe disability (mRS 5: HR 7.6; 2.7 to 20) and a nondisabled vs disabled state before recurrence (HR 4.0; 2.3 to 6.8).
Conclusions: The rate of recovery from recurrent ischemic stroke was greatest in the first 6 months; one-third of patients recovered within 12 months. The significant predictors of recovery were a nondisabled state before recurrence and increasing severity of the recurrent stroke.
The MATCH Trial was sponsored by sanofi-synthelabo recherche and cofunded in the USA by sanofi-synthelabo and Bristol Myers Squibb.
Disclosure: G.J.H. was an investigator in the MATCH Trial and has received consulting fees and honoraria from sanofi-aventis and Bristol Myers Squibb. All other authors are employees of sanofi-aventis recherche and développement.
Presented in part as an oral presentation at the 14th European Stroke Conference, 25 to 28 May 2005, Bologna, Italy.
Received March 21, 2006. Accepted in final form September 29, 2006.
Related Article
Neurology 2007 68: 168-169.
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