Influencing factors of early dramatic recovery of neurological function after intravenous thrombolysis in patients with branch atheromatous disease

Abstract

Background: Intravenous thrombolysis can significantly improve the neurological function of patients with acute ischemic stroke. However, the expected early dramatic recovery (EDR) of neurological function after thrombolysis is not achieved in some patients with branch atheromatous disease (BAD). Here we evaluated the factors associated with EDR after thrombolysis in BAD patients. Methods: We conducted a retrospective study on 580 consecutive BAD patients. All patients met the diagnostic criteria of BAD and received intravenous recombinant tissue-type plasminogen activator (rt-PA). EDR was defined when the improvement of National Institutes of Health Stroke Scale (NIHSS) score was >8 points within 2 or 24 hours after rt-PA, or the total NIHSS score was 0 or 1. The factors associated with EDR were analyzed with multivariate logistic regression analysis. Results: Among 580 patients, the incidence of EDR was 35.2% (204 cases). Compared with patients without EDR, patients with EDR had lower incidence of diabetes (15.7% vs 29.3%, P < .001), lower NIHSS scores at 2 and 24 hours after rt-PA ( P < .001), less cerebral hemorrhage (0% vs 5.3%, P = .001), and shorter onset to treatment time (OTT) ( P < .001). Multivariate logistic regression analysis in propensity score-matched cohort showed that EDR was associated with OTT (adjusted OR = 0.994; 95% CI, 0.989–0.999) and NIHSS score after rt-PA (adjusted OR = 0.768; 95% CI, 0.663–0.890). Notably, diabetes (adjusted OR = 0.477, 95% CI, 0.234–0.972) was an independent factor related to EDR of neurological function in BAD patients. In the subgroup analysis, a lower incidence of diabetes (adjusted OR = 0.205, 95% CI: 0.059–0.714, P = .013) and a lower NIHSS score after thrombolysis in patients with paramedian pontine infarction (adjusted OR = 0.809, 95% CI: 0.656–0.997, P = .047) were significantly associated with EDR. Conclusion: Diabetes is not conducive to EDR of neurological function in patients with BAD, especially in patients with paramedian pontine infraction. Low NIHSS score and short OTT after thrombolysis may be closely related to EDR after intravenous thrombolysis.

Optimizing early neurological deterioration prediction in acute ischemic stroke patients following intravenous thrombolysis: a LASSO regression model approach

“…In our study, we developed a comprehensive predictive model integrating various factors closely associated with END post-IVT in patients with AIS. This model incorporates traditional stroke risk factors, such as age ( Tschirret et al, 2018 ; Girot et al, 2020 ) and blood glucose levels ( Simonsen et al, 2016 ; Huang et al, 2018 ; Meng et al, 2023 ), alongside emerging indicators like SII ( Wei et al, 2023 ), providing a more holistic risk assessment. Specifically, the inclusion of past stroke history ( Li et al, 2020 ; Jin et al, 2023 ) is pivotal as it may indicate an underlying state of cerebral vascular health in patients.…”

“…Specifically, the inclusion of past stroke history ( Li et al, 2020 ; Jin et al, 2023 ) is pivotal as it may indicate an underlying state of cerebral vascular health in patients. Body mass index (BMI) ( Tian et al, 2023 ) and onset-to-treatment time (OTT) ( Meng et al, 2023 ; Shi et al, 2023 ) are also critical variables, reflecting the overall health condition of the patient and the timeliness of treatment, respectively. These factors are essential for predicting the efficacy of treatment.…”

“…In our study, we developed a comprehensive predictive model integrating various factors closely associated with END post-IVT in patients with AIS. This model incorporates traditional stroke risk factors, such as age (Tschirret et al, 2018;Girot et al, 2020) and blood glucose levels (Simonsen et al, 2016;Huang et al, 2018;Meng et al, 2023), alongside emerging indicators like SII (Wei et al, 2023), providing a more holistic 10.3389/fnins.2024.1390117…”