Early Neurological Deterioration in Acute Ischemic Stroke Patients after Intravenous Thrombolysis with Alteplase Predicts Poor 3-Month Functional Prognosis - Data from the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China)

Abstract

Background： We aimed to investigate the risk factors of early neurological deterioration (END) after intravenous thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) and the relationship between END and poor 3-month functional outcomes.Methods: Patients who accepted intravenous recombinant rt-PA were enrolled continuously. END was defined as an increase of National Institute of Health Stroke (NIHSS) score ≥ 4 points or death within 24 hours after intravenous thrombolysis. The modified Rankin Scale (mRS) score was recorded to evaluate the functional prognosis of stroke, and the poor 3-month prognosis was defined as an mRS score ≥ of 3. Univariate and multivariate analyses were used to analyze the risk factors of END. The relation between END and 3-month functional outcome was analyzed by multivariate logistic regression analysis. Results: A total of 1107 patients (mean age, 63.42±11.33 years; 673 males) were included in the final analysis, and 81(7.32%) patients had END. In multivariate analysis, the serum glucose level was significantly associated with END; the odds ratio was 1.10 (95% CI 1.03 to 1.18, p =0.004). The multivariate logistic analysis showed END has a notable association with the poor 3-month functional recovery even after adjusting for confounding factors; the adjusted OR was 8.25 (95% CI 3.77 to 18.03, p<0.0001). Conclusions: The initial serum glucose level might be an independent risk factor of END, and END might predict a poor 3-month prognosis.

Very early neurological deterioration after thrombolysis in patients with acute ischemic stroke

“…This study revealed that VEND had a significant detrimental impact on 3-month functional outcomes, in concordance with previous findings for END. 29,30 Of note, this study further revealed that VEND significantly predicted poor outcomes in both minor and non-minor stroke patients. A prior study showed that 12% of patients who received thrombolysis therapy for acute minor ischemic stroke due to large vessel occlusion developed ischemic END and 48% of the END occurred within 2 h, which was associated with worse 3-month functional outcomes even after rescue thrombectomy.…”