Hypoperfusion in lenticulostriate arteries territory related to unexplained early neurological deterioration after intravenous thrombolysis

Abstract

Background: Early neurological deterioration occurs in approximately 10% acute ischemic stroke patients after thrombolysis. Over half of the early neurological deterioration occurred without known causes and is called unexplained early neurological deterioration. Aims: We aimed to explore the development of early neurological deterioration at 24 h after thrombolysis, and whether it could be predicted by the presence of baseline hypoperfusion in lenticulostriate arteries territory in acute ischemic stroke patients. Methods: We retrospectively reviewed our prospectively collected database of acute ischemic stroke patients in the unilateral middle cerebral artery territory who had baseline perfusion image and received thrombolysis. Unexplained early neurological deterioration was defined as ! 2 points increase of National Institutes of Health Stroke Scale (NIHSS) from baseline to 24 h, without known causes. Hypoperfusion lesions in different territories were identified on perfusion maps. Results: A total of 306 patients were included in analysis. Patients with pure lenticulostriate arteries hypoperfusion (defined as the presence of hypoperfusion in lenticulostriate artery territory, but not in middle cerebral artery terminal branch territory) were more likely to have unexplained early neurological deterioration than others (27.6% vs. 6.1%; OR, 5.974; p ¼ 0.001), after adjusting for age, baseline NIHSS and onset to treatment time. Conclusions: Patients presenting hypoperfusion in pure lenticulostriate arteries territory were easier to experience unexplained early neurological deterioration.

Acute in‐hospital blood pressure variability predicts early neurological deterioration in acute minor stroke or transient ischemic attack with steno‐occlusive arterial disease

“…To prove the association of BPV and END, we adopted a definition of END as a ≥1‐point increase in NIHSS score during the first 72 hours after admission. And, the rate of END was 32.5% in this study, which was consistent with the rates in previous studies . And also, our findings were similar to that in the Chungs' study .…”

“…And, the rate of END was 32.5% in this study, which was consistent with the rates in previous studies. [4][5][6][7][8][9][10] And also, our findings were similar to that in the Chungs' study. 16 Both studies suggested that the acute in-hospital BPV was strongly associated with the risk of having a END.…”

“…Therefore, it is of great importance to identify factors associated with END in patients with acute minor stroke or TIA due to steno‐occlusive arterial disease. Based on the previous studies, several clinical and biological factors, such as older age, the initial neurological severity, diabetes mellitus, and blood pressure, might influent the development of END in patients with general ischemic stroke . To our best known, few studies focus on patients with acute minor stroke or TIA due to steno‐occlusive arterial disease.…”

“…Based on the previous studies, several clinical and biological factors, such as older age, the initial neurological severity, diabetes mellitus, and blood pressure, might influent the development of END in patients with general ischemic stroke. [8][9][10][11] To our best known, few studies focus on patients with acute minor stroke or TIA due to steno-occlusive arterial disease.…”

Minor Non-Disabling Stroke Patients with Large Vessel Severe Stenosis or Occlusion Might Benefit from Thrombolysis

“…Further analysis from our data demonstrated that minor non-disabling stroke with severe stenosis/occlusion could benefit from alteplase-treatment. Neurological deterioration commonly occurred in patients with severe stenosis of large vessels [ 11 , 18 , 19 ] It was reported that patients with mild deficits (NIHSS ≤ 5) and large vessel occlusion deteriorated more often in non-thrombolyzed patients than thrombolyzed patients within 3 months after onset [ 20 ]. Meanwhile, the NIHSS score was unable to exactly reflect the presence of intracranial artery occlusion.…”