scholarly journals Clinical-CT mismatch defined NIHSS ≥ 8 and CT-ASPECTS ≥ 9 as a reliable marker of candidacy for intravenous thrombolytic therapy in acute ischemic stroke

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0251077
Author(s):  
Hung-Ming Wu ◽  
I-Hui Lee ◽  
Chao-Bao Luo ◽  
Chih-Ping Chung ◽  
Yung-Yang Lin
Keyword(s):  
Thrombolytic Therapy ◽  
Intravenous Thrombolysis ◽  
Incidence Rates ◽  
Favorable Outcome ◽  
Stroke Severity ◽  
Lesion Volume ◽  
Nihss Score ◽  
Neurological Improvement ◽  
Early Neurological Deterioration ◽  
Reliable Marker

Background Clinical-diffusion mismatch between stroke severity and diffusion-weighted imaging lesion volume seems to identify stroke patients with penumbra. However, urgent magnetic resonance imaging is sometimes inaccessible or contraindicated. Thus, we hypothesized that using brain computed tomography (CT) to determine a baseline “clinical-CT mismatch” may also predict the responses to thrombolytic therapy. Methods Brain CT lesions were measured using the Alberta Stroke Program Early CT Score (ASPECTS). A total of 104 patients were included: 79 patients with a baseline National Institutes of Health Stroke Scale (NIHSS) score ≥ 8 and a CT-ASPECTS ≥ 9 who were defined as clinical-CT mismatch-positive (P group) and 25 patients with an NIHSS score ≥ 8 and a CT-ASPECTS < 9 who were defined as clinical-CT mismatch-negative (the N group). We compared their clinical outcomes, including early neurological improvement (ENI), early neurological deterioration (END), delta NIHSS score (admission NIHSS—baseline NIHSS score), symptomatic intracranial hemorrhage (sICH), mortality, and favorable outcome at 3 months. Results Patients in the P group had a greater proportion of favorable outcome at 3 months (p = 0.032) and more frequent ENI (p = 0.038) and a greater delta NIHSS score (p = 0.001), as well as a lower proportion of END (p = 0.004) than those in the N group patients. There were no significant differences in the incidence rates of sICH and mortality between the two groups. Conclusions Clinical-CT mismatch may be able to predict which patients would benefit from intravenous thrombolysis.

scholarly journals High neutrophil-to-lymphocyte ratio predicts early neurological deterioration in spontaneous intracerebral hemorrhage patients

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Wafaa S. Mohamed ◽  
Amr E. Kamel ◽  
Ahmed H. Abdelwahab ◽  
Mohamed E. Mahdy
Keyword(s):  
Intracerebral Hemorrhage ◽  
Complete Blood Count ◽  
Absolute Lymphocyte Count ◽  
Neurological Deterioration ◽  
University Hospital ◽  
Stroke Severity ◽  
Low Grade ◽  
Nihss Score ◽  
Early Neurological Deterioration ◽  
Gcs Score

Abstract Background Intracerebral hemorrhage (ICH) is caused by bleeding, primarily into parenchymal brain tissue, and accounts for 9 to 27% of all strokes worldwide. Higher neutrophils, lower lymphocytes, and higher neutrophil-to-lymphocytes ratio (NLR) values predict worse outcomes after spontaneous intracranial hemorrhage (sICH) and could aid in the risk stratification of patients. Methods Eighty patients with sICH within the first 24 h of stroke onset and admitted into the neurology intensive care unit of an Egyptian university hospital and were assessed by GCS for consciousness level and NIHSS for stroke severity assessment, complete blood count, and special attention to NLR. Patients were reevaluated by GCS and NIHSS on the 7th day of the stroke. Early neurological deterioration (END) was defined as four points or a greater increase in the NIHSS score or two points or a greater decrease in GCS or death. Results END was recorded in 21.25% of patients while non-END was recorded in 78.75%. END was highly significantly associated with a low grade of GCS, high grade of NIHSS, elevated absolute lymphocyte count (ALC), and elevated NLR. Lower GCS score, higher NIHSS score, larger hematoma volume, and higher NLR values were independent predictors for END. The best cutoff of NLR in END prediction was > 9.1. Conclusion NLR is a trustworthy early predictor of sICH outcome.

Abstract 118: Diffusion Lesion Volume Reduction after Recanalization Therapy for Anterior Circulation Stroke with Major Vessel Occlusion: Analysis from the RESCUE-Japan Registry Study

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Mikito Hayakawa ◽  
Hiroshi Yamagami ◽  
Kazunori Toyoda ◽  
Yuji Matsumaru ◽  
Yukiko Enomoto ◽  
...  
Keyword(s):  
Intravenous Thrombolysis ◽  
Volume Reduction ◽  
Lesion Volume ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Nihss Score ◽  
Median Baseline ◽  
Point Reduction ◽  
Major Vessel

Objective: Although Diffusion-weighted imaging (DWI) lesions are commonly irreversible, DWI lesion volume reduction (DVR) is occasionally observed. We investigated clinical significance and predictors of DVR in acute stroke patients with major vessel occlusion receiving recanalization therapy (RT). Methods: The Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism (RESCUE)-Japan registry prospectively registered 1,442 stroke patients with major vessel occlusion who were admitted to 84 Japanese stroke centers within 24 hours after onset from July 2010 to June 2011. We retrospectively analyzed all patients with the internal carotid artery or middle cerebral artery (M1 or M2 segments occlusions receiving RT and undergoing MRI both on admission and at 24 hours after onset from the registry. We defined DVR as a 1 or more-point reduction of the DWI-Alberta Stroke Program Early CT Score (ASPECTS), and CT-DWI mismatch (CTDM) as a 2 or more-point lower DWI-ASPECTS than CT-ASPECTS on admission. Reperfusion was defined as TICI grade 2b-3 on catheter angiography or modified Mori grade 3 on MRA immediately after RT. Dramatic recovery (DR) was defined as a 10 or more-point reduction or a total NIHSS score of 0-1 at 24 hours, and favorable outcome (FO) defined as a mRS score 0-2 at 3 months. Results: A total of 390 patients (215 men, 72 years old,) was included. Median baseline NIHSS score was 16 (IQR 10-19) and median baseline DWI-ASPECTS was 8 (6-9). CTDM was seen in 92 patients (28%) on admission. Intravenous thrombolysis and endovascular therapy were performed in 246 patients (63%) and 223 patients (57%), respectively. Reperfusion was obtained in 170 patients (51%). DVR was seen in 51 patients (13%). Eighty-eight patients (23%) obtained DR and 158 patients (41%) achieved FO. On multivariate analyses, DVR was significantly related to DR (OR 3.8, 95%CI 1.5-10) and FO (4.6, 1.8-12). CTDM was an independent predictor of DVR (OR 2.5, 95% CI 1.1-5.8). Conclusions: DVR was significantly related to DR and FO. CTDM is a rough predictor of DVR of which area is considered as a “DWI-bright” ischemic penumbra, and might be a useful marker to identify the adequate candidates for RT in spite of relatively large DWI lesions.

scholarly journals Clinical profile of patients with acute ischemic stroke receiving intravenous thrombolysis (rtPA-alteplase)

2018 ◽  
Vol 5 (1) ◽  
pp. 164
Author(s):  
Shiva Prasad Jagini ◽  
Suresh I.
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Prospective Observational Study ◽  
Primary Outcome ◽  
Intravenous Thrombolysis ◽  
Clinical Profile ◽  
Favorable Outcome ◽  
Nihss Score ◽  
The Mean ◽  
Centre Hospital

Background: Stroke patients are at highest risk death in the first few weeks after the event, and between 20-50% die within first month depending on type, severity, age, co-morbidities and effectiveness of treatment of complications. Objective of this study was to clinical profile of patients with acute ischemic stroke receiving intravenous thrombolysis (rtPA-alteplase).Methods: Prospective Observational study of 26 cases of acute ischemic stroke receiving IV thrombolysis using rtPA-alteplase at Kovai Medical Centre Hospital, Coimbatore over a period of 1 year 9 months.Results: 21 cases had NIHSS score of range 10 to 22. The mean NIHSS score at admission is 13.5. 15 subjects (57.7%) had achieved primary outcome in this study. MRS Score of 0 to 2 is considered as favorable outcome. In this study 20 subjects (76.92 %) had favorable outcome at the end of 3 months.Conclusions: Majority of the patients receiving rtPA-alteplase had favorable outcome.

Abstract 145: Outcome in Patients with Minor Stroke: The Effect of Itemized NIHSS Score Subsets

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Shadi Yaghi ◽  
Joshua Z Willey ◽  
Howard Andrews ◽  
Amelia K Boehme ◽  
Leigh Quarles ◽  
...  
Keyword(s):  
Intravenous Thrombolysis ◽  
Minor Stroke ◽  
Motor Deficits ◽  
Stroke Severity ◽  
Nihss Score ◽  
Discharge Disposition ◽  
Discharge Home ◽  
Dichotomous Variable ◽  
Secondary Analyses ◽  
Multivariable Regression

Background: The use of the National Insitutes of Health Stroke Scale (NIHSS) to assess stroke severity in minor stroke is controversial. We hypothesized that patients with cortical signs on the itemized NIHSS subsets (neglect, visual, or language) will have a worse outcome than those without. Methods: Data was retrieved from the Columbia SPOTRIAS dataset. All patients with NIHSS between 0 and 5 within 12 hours from symptom onset who were not treated with intravenous thrombolysis were included. Patients were followed prospectively as part of the “Stroke Warning Information and Faster Treatment” Study. Poor outcome was defined as not being discharged home and analyzed using multivariable logistic regression. The primary predictor was cortical features on the itemized NIHSS. Individual components of the NIHSS score, treated as a dichotomous variable, as well as the admission NIHSS score were assessed in secondary analyses. Results: The sample included 894 patients, of which 162 (18%) were not discharged home. In multivariable regression analysis of baseline demographics, risk factors, median NIHSS, and cortical signs, only mean age (OR = 1.02, P<0.001) and NIHSS score (OR = 1.59, p<0.001) were associated with non-discharge home. In secondary analyses having any score on the following items predicted non-discharge home: Motor (OR = 2.40, p<0.001), LOC (OR = 6.67, p=0.004), and Ataxia (OR = 3.21, p<0.001). Other items from the NIHSS were not associated with discharge disposition. Motor deficits (AUC 0.623) appeared to be more predictive of discharge outcome than ataxia (AUC 0.569) and LOC deficits (AUC 0.517). In addition, the admission NIHSS had a fair correlation with discharge outcome (AUC 0.683). Conclusion: Deficits in LOC, motor weakness, and ataxia predict discharge outcome in patients with mild stroke, with the motor score being the most influential component. This may potentially alter treatment decisions in this population. The fair correlation between NIHSS score and discharge outcome suggests that certain factors not captured by the NIHSS score may contribute to discharge outcome in this patient population.

Changes in Activated Thrombin-Activatable Fibrinolysis Inhibitor Levels Following Thrombolytic Therapy in Ischemic Stroke Patients Correlate with Clinical Outcome

2016 ◽  
Vol 42 (5-6) ◽  
pp. 404-414 ◽  
Author(s):  
Marie-Christine Alessi ◽  
Christophe Gaudin ◽  
Philippe Grosjean ◽  
Valérie Martin ◽  
Serge Timsit ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Clinical Severity ◽  
Tissue Type ◽  
Stroke Severity ◽  
Thrombin Activatable Fibrinolysis Inhibitor ◽  
Nihss Score ◽  
Multicenter Observational Study ◽  
Fibrinolysis Inhibitor ◽  
Prospective Longitudinal

Background and Purpose: Thrombin-activatable fibrinolysis inhibitor (TAFI) activation following thrombolysis may affect thrombolysis effectiveness in acute ischemic stroke (AIS). To support this hypothesis, we propose to study the relationship between TAFI consumption, activated/inactivated TAFI (TAFIa/ai) and stroke severity and outcome in 2 groups of AIS patients, one treated and one untreated with intravenous recombinant tissue type plasminogen activator (rt-PA). Methods: In this prospective, longitudinal, multicenter, observational study, we aimed to study the association between TAFIa/ai and stroke outcome. TAFI levels were sequentially measured in patients treated with intravenous rt-PA thrombolysis (T), and in patients not given any thrombolytic therapy (NT). Baseline reference values were established in healthy subjects matched for age and gender. The National Institutes of Health Stroke Scale (NIHSS) score assessed at baseline and on day 2 was dichotomized into 2 severity groups (0-7 vs. >7). The modified Rankin Scale (mRS) score at day 90 was dichotomized for favorable (0-1) and unfavorable (2-6) outcomes. Results: A total of 109 patients were included, with 41 receiving rt-PA. At admission, patients had higher TAFIa/ai levels than reference. A significant increase in TAFIa/ai levels was observed at the end of thrombolysis (mean change from baseline of 963%) and lasted up to 4 h (191%). Higher TAFIa/ai levels were associated with a more severe day 2 NIHSS score (p = 0.0098 at T2h post thrombolysis) and an unfavorable mRS score from T48h (p = 0.0417) to day 90 (p = 0.0046). In NT patients, higher TAFIa/ai levels at admission were associated with a more severe stroke, as assessed by day 2 NIHSS score (p = 0.0026) and mRS score (p = 0.0003). Conclusion: These data demonstrate a consistent relationship between TAFI levels and early clinical severity during rt-PA treatment.

Management of tandem occlusion stroke with endovascular therapy

2012 ◽  
Vol 32 (5) ◽  
pp. E16 ◽  
Author(s):  
Haitham Dababneh ◽  
Waldo R. Guerrero ◽  
Anna Khanna ◽  
Brian L. Hoh ◽  
J Mocco
Keyword(s):  
Mechanical Thrombectomy ◽  
Intravenous Thrombolysis ◽  
National Institutes Of Health ◽  
Nihss Score ◽  
Neurological Improvement ◽  
Point Reduction ◽  
Mca Occlusion ◽  
Tandem Occlusion ◽  
Multimodality Approach ◽  
Extracranial Ica

Object Approximately 25% of patients with middle cerebral artery (MCA) occlusion will have a concomitant internal carotid artery (ICA) occlusion, and 50% of patients with an ICA occlusion will have a proximal MCA occlusion. Cervical ICA occlusion with MCA embolic occlusion is associated with a low rate of recanalization and poor outcome after intravenous thrombolysis. The authors report their experience with acute ischemic stroke patients who suffered tandem ICA/MCA (TIM) occlusions and underwent intravenous thrombolysis followed by extracranial ICA angioplasty and intracranial MCA mechanical thrombectomy. Methods In a retrospective analysis of their stroke database (2008–2011), the authors identified 2 patients with TIM occlusion treated with intravenous thrombolysis followed by extracranial ICA angioplasty and intracranial mechanical thrombectomy. They examined early neurological improvement defined by a greater than 10-point reduction of National Institutes of Health Stroke Scale (NIHSS) score and an improved modified Rankin Scale (mRS) score at 60 days. Successful recanalization based on thrombolysis in cerebral infarction (TICI) score of 2 or 3 was also evaluated. Results In both patients a TICI score of 2b or 3 was achieved, signifying successful recanalization. In addition, both patients had a reduction in the NIHSS score by greater than 10 points and an mRS score of 0 at 60 days. Conclusions Tandem occlusions of the cervical ICA and MCA may be successfully treated using the multimodality approach of intravenous thrombolysis followed by extracranial ICA angioplasty and intracranial mechanical thrombectomy.

scholarly journals 726 Outcomes of ischaemic stroke in patients with atrial fibrillation

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Teresa Strisciuglio ◽  
Valerio Pergolae ◽  
Giuseppe Ammirati ◽  
Lucio Addeo ◽  
Gaetano Todde ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Mechanical Thrombectomy ◽  
Intravenous Thrombolysis ◽  
Neurological Impairment ◽  
Neurological Recovery ◽  
Stroke Severity ◽  
Severe Stroke ◽  
Neurological Improvement ◽  
History Of ◽  
Different Response

Abstract Aims Atrial fibrillation (AF) increases the risk of ischaemic strokes (IS) and is associated with a more severe neurological impairment. We sought to investigate whether AF also impacts the neurological recovery and whether patients with AF have a different response to the treatment. Methods and results Data of patients admitted to the Stroke Unit of our institution from January to December 2020 were retrieved from the local database. The stroke severity was calculated by mean of the National Institute of Health Stroke Scale (NIHSS) at hospital admission (NIHSSad), at 24 h (NIHSS24) and at discharge (NIHSSdis). The functional capacity was assessed by the modified Rankin score (mRS). As for the neurological recovery, this was assessed by the delta NIHSS at 24 h (Δ24 = NIHSS24−NIHSSad) and at discharge (Δdis = NIHSSdis−NIHSSad). Out of 545 patients with IS 64 had known history of AF or were admitted with AF. Patients with AF had higher NIHSSad (13.9 ± 7 vs. 8.5 ± 7; P &lt; 0.001) and NIHSS24 (9.6 ± 8 vs. 6.4 ± 7; P = 0.007) than patients without, however the neurological improvement was greater (Δdis −7.4 ± 9 vs. −3.4 ± 6; P = 0.002), indeed the NIHSSdis was similar (4.2 ± 5 vs. 4.2 ± 6; P = 0.98). Patients with AF also had a more impaired mRS before the ischaemic event and at discharge (2.4 ± 1.9 vs. 1.6 ± 1.7, P = 0.02; 1.2 ± 1.2 vs. 0.4 ± 0.9, P &lt; 0.001). Among AF patients with CHADVASC ≥ 3, 34% of them were taking antiplatelet therapy, 31% anticoagulants, and 35% didn’t take any therapy. Of interest, no differences in the NIHSSad nor in the NIHSSdis were found between them and neither in the Δdis. As for the treatment of AF patients, no differences in the neurological recovery were observed between those treated with intravenous thrombolysis and those not treated at all (Δdis 2.8 ± 5 vs. 2.8 ± 8, P = 1), whereas the Δdis was significantly higher in patients treated with mechanical thrombectomy (−11.7 ± 7, P = 0.007). Conclusions Patients with AF experience more severe stroke, however the neurological recovery is greater than in patients without the arrhythmia. The treatment with antiplatelets or anticoagulants before the event does not reduce the severity of the stroke and does not influence the improvement of the NIHSS at discharge. The mechanical thrombectomy is more effective in reducing the neurological impairment.

Abstract 58: The Iscore Predicts Efficacy Of Thrombolytic Therapy For Acute Ischemic Stroke

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Gustavo Saposnik ◽  
Jiming Fang ◽  
Moira Kapral ◽  
Jack Tu ◽  
Muhammad Mamdani ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Acute Ischemic Stroke ◽  
Clinical Response ◽  
Intravenous Thrombolysis ◽  
Hemorrhagic Transformation ◽  
Neurological Deterioration ◽  
Stroke Severity ◽  
Risk Of Death ◽  
Poor Outcome

Background: The iScore is a validated tool developed to estimate the risk of death and functional outcomes early after an acute ischemic stroke. It includes demographics, stroke severity and subtype, vascular risk factors, cancer, renal failure, and pre-admission functional status. Limited information is available to predict the clinical response after intravenous thrombolytic therapy (tPA). Objective: To determine the ability of the iScore to predict the clinical response and risk of hemorrhagic transformation after tPA. Methods: We applied the iScore ( www.sorcan.ca/iscore ) to patients presenting with an acute ischemic stroke at 11 stroke centres in Ontario, Canada, between 2003 and 2008, identified from the Registry of the Canadian Stroke Network (RCSN). We compared outcomes between patients receiving and not receiving tPA adjusting for differences in baseline characteristics through matching by propensity scores. Three groups were defined a priori as per the iScore (low risk 180). Outcome Measures: Poor outcome, the primary outcome measure, was defined as disability at discharge or death at 30 days. Secondary outcomes included disability at discharge, neurological deterioration and intracranial hemorrhage (any type and symptomatic). Results: Among 12,686 patients with an acute ischemic stroke, 1696 (13.4%) received intravenous thrombolysis. Overall, 589 tPA patients were matched with 589 non-tPA patients (low iScore risk), 682 tPA were matched with 682 non-tPA patients (medium iScore risk) and 419 tPA patients were matched with 419 non-tPA patients (high iScore risk). There was good matching in all three groups. Higher iScore was associated with poor functional outcome in both the tPA and non-tPA groups (p<0.001). Among those with low and medium iScore risk, tPA use was associated with lower risk of poor outcome (Low iScore RR 0.74; 95%CI 0.67-0.84; medium iScore RR 0.88; 95%CI 0.84-0.93). There was no difference in clinical outcomes between matched patients receiving and not receiving tPA in the highest iScore group (RR 0.97; 95%CI 0.94-1.01). Similar results were observed for disability at discharge and length of stay. The incident risk of neurological deterioration and hemorrhagic transformation (any or symptomatic) increased with the iScore risk ( Figure ). Conclusion: The iScore appears to predict clinical response and risk of hemorrhagic complications after tPA for an acute ischemic stroke. Patients with high iScores may not benefit from tPA and have higher risk of hemorrhagic transformation, though this finding should be validated independently (underway) before clinical use.

scholarly journals Compressed Sensing Algorithm-Based Magnetic Resonance Imaging Guided for Prognosis of Early Neurological Deterioration after Intravenous Thrombolysis in Ischemic Stroke Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Yiwei Huang ◽  
Xiaoyun Sun ◽  
Yinping Yao ◽  
Yejun Chen ◽  
Yan Chen ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Risk Factors ◽  
Univariate Analysis ◽  
Intravenous Thrombolysis ◽  
Neurological Deterioration ◽  
Resonance Imaging ◽  
Blood Cell Count ◽  
Nihss Score ◽  
Early Neurological Deterioration ◽  
Watershed Infarction

This work was aimed to study the risk factors and prognostic treatment for acute ischemic stroke (AIS) patients with early neurological deterioration (END) after intravenous thrombolytic therapy via compressed sensing algorithm-based magnetic resonance imaging (CS-MRI). 231 patients who were diagnosed with AIS were selected, and the final involved number of patients was 182. Patients with AIS were treated with intravenous thrombolysis with alteplase within 4.5 hours of onset. After treatment, patients with early neurological deterioration were defined as the deteriorating group and those without early neurological impairment were defined as the nondeteriorating group. In univariate analysis, hypertension, white blood cell count, and National Institutes of Health Stroke Scale (NIHSS) score were correlated with the occurrence of END. Under the CS-MRI theory, the two groups of patients were evaluated for middle cerebral artery basal ganglia infarction and internal watershed infarction. After univariate analysis, the P < 0.1 variables were taken as the independent variable, and the binary logistic regression model was adopted for multivariate regression analysis. It was disclosed that NIHSS score was not correlated with the occurrence of early neurological function deterioration, while homocysteine was. Hypertension, white blood cell count, homocysteine, and NIHSS score were risk factors for END. The image analysis revealed that the incidence of deteriorating basal ganglia infarction group was lower relative to the nondeteriorating group, and the incidence of watershed infarction was higher in the deteriorating group versus the nondeteriorating group. The image analysis suggested that predicting the occurrence of END through risk factors can actively provide endovascular treatment for patients with AIS.

scholarly journals Clinical and radiological factors predict unexplained early neurological deterioration after intravenous thrombolysis in patients with acute middle cerebral artery stroke

2019 ◽  
Author(s):  
Yiping Ding ◽  
Tong Sun ◽  
Yue Lu ◽  
Shuangjiao Huang ◽  
Shanshan Diao ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Univariate Analysis ◽  
Intravenous Thrombolysis ◽  
Neurological Deterioration ◽  
Nihss Score ◽  
Early Neurological Deterioration ◽  
Middle Cerebral Artery Stroke ◽  
Proximal Occlusion ◽  
Multimodal Ct

Abstract Background Some patients with acute middle cerebral artery stroke (MCA-stroke) cannot benefit from thrombolysis and develop early neurological deterioration (END) within 24 hours. Except for several defenitive causes such as symptomatic intracerebral hemorrhage, malignant edema, and early recurrent stroke, no definitive mechanism (unexplained END) account for majority of END cases deserving our attention. Methods We retrospectively collected 142 MCA-stroke patients who had pretreatment multimodal CT including non-contrast CT (NCCT), CT angiography (CTA) and CT perfusion (CTP) and received intravenous thrombolytic therapy within 4.5h of onset and. Unexplained END was denited as NIHSS scores increased from baseline within 24 hours after thrombolysis ≥ 4 points or death without definite causes. The clinical and imaging data based on multimodal CT were compared between unexplained END and no END through univariate and multivariate regression analyses. Results The prevalence of unexplained END (24 patients, 16.9%) outnumbered the prevalence of END due to other causes. Univariate analysis showed that higher admission glucose (P= 0.039), lower initial NIHSS score (P=0.026), lower r-LMC score (P= 0.003), proximal occlusion (P=0.003) and large penumbra volume(P<0.001) were more frequently observed in patients with unexplained END; In multivariate analysis, lower NIHSS score (OR=1.19; 95% CI, 1.07-1.32; P=0.001), proximal occlusion (OR=0.32; 95% CI, 0.06-0.92; P=0.038), lower r-LMC score (OR=1.17; 95% CI, 1.02-1.35; P=0.028) and larger penumbra volume (OR=0.98; 95% CI, 0.96-0.99; P=0.003) were associated with unexplained END. Conclusion Lower NIHSS score, proximal occlusion, lower r-LMC score and larger penumbra volume can predict unexplained END in the hyperacute phase of MCA-stroke and contribute to develop treatment strategies.

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