Impact of Brain Atrophy on Early Neurological Deterioration and Outcome in Severe Ischemic Stroke Treated by Intravenous Thrombolysis

2018 ◽  
Vol 79 (5-6) ◽  
pp. 240-246 ◽  
Author(s):  
Olivier Tschirret ◽  
Gabriela Moreno Legast ◽  
Adeline Mansuy ◽  
Nathan Mewton ◽  
Marielle Buisson ◽  
...  
Keyword(s):  
Brain Atrophy ◽  
Multiple Logistic Regression Analysis ◽  
Univariate Analysis ◽  
Intravenous Thrombolysis ◽  
National Institutes Of Health ◽  
Neurological Deterioration ◽  
Good Outcome ◽  
Early Neurological Deterioration ◽  
Backward Procedure ◽  
Proximal Occlusion

Background: Brain atrophy has shown a protective effect on the risk of early neurological deterioration (END) related to malignant edema in patients with hemispheric infarction but could be deleterious on the outcome. Aims: We aimed to assess whether brain atrophy has an impact on the risk of END and on the outcome in severe ischemic strokes after intravenous (IV) thrombolysis. Methods: From a prospective thrombolysis registry, 137 patients who had a National Institutes of Health Stroke Scale (NIHSS) ≥15, MRI at admission, and IV thrombolysis were included. Relative cerebral volume was calculated. END was defined as a ≥2-points deterioration 72-h NIHSS and a good outcome as a modified Rankin Scale (mRS) ≤2 at 3 months. A multiple logistic regression analysis with a stepwise backward procedure was performed. Results: END and a good outcome were observed, respectively, in 20 (14.6%) and 48 (37.5%) patients. In univariate analysis, predictors of END included age (p = 0.049), diabetes (p = 0.041), and parenchymal hemorrhage (p = 0.039). In multivariate analysis, age (p = 0.018) was significantly associated with END. Brain atrophy was not associated with END even in subgroup analysis according to the baseline infarct size. In univariate analysis, age (p = 0.003), prestroke mRS (p = 0.002), hypertension (p = 0.006), baseline NIHSS (p = 0.002), END (p = 0.002), proximal occlusion (p = 0.006), and recanalization at 24 h (p < 0.001) were associated with a good outcome. Only baseline NIHSS (p = 0.006) was associated with a good outcome after adjustment. Conclusions: We did not find any impact of brain atrophy on the risk of END and the outcome at 3 months in severe ischemic strokes after IV thrombolysis.

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.

Abstract 101: Predictors of Early Neurological Deterioration in Minor Strokes With Large Vessel Occlusion Treated With Intravenous Thrombolysis. A French Multicentric Observational Study (MINOR-STROKE)

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Pierre Seners ◽  
Claire Perrin ◽  
Guillaume Turc
Keyword(s):  
Basilar Artery ◽  
Multivariable Analysis ◽  
Intravenous Thrombolysis ◽  
Neurological Deterioration ◽  
Large Vessel ◽  
Minor Stroke ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Early Neurological Deterioration ◽  
Proximal Occlusion

Introduction: Whether thrombectomy added on intravenous thrombolysis (IVT), as compared to IVT alone, is beneficial in minor strokes with large vessel occlusion (LVO) is unknown. To identify predictors of early neurological deterioration (END) following IVT alone may help to select the best candidates for additional thrombectomy. Methods: MINOR-STROKE was a multicentric retrospective registry collecting data of IVT-treated minor strokes (NIHSS≤5) with LVO (internal carotid artery [ICA], M1, M2 or basilar artery; with central reading) treated with or without additional thrombectomy in 45 French stroke units. The patients initially intended for IVT alone, including those who eventually received thrombectomy due to END, were included in the present analysis. END was defined as a ≥4 points on NIHSS within 24hrs following admission. Thrombus length was measured centrally either on T2*-MRI, CT (hyperdense middle cerebral artery) or CT-angiography. Results: Overall, 799 patients were included: mean age 69 years, median NIHSS 3, occlusion located in ICA±M1/M2, proximal M1, distal M1, M2, or basilar artery in 20%, 7%, 19%, 50% and 4% of patients, respectively. Thrombus was visible in 78% of patients (median length 9mm, IQR 6-12mm). END occurred in 15% of patients and was associated with poor 3-month functional outcome (mRS>2: 55% vs. 12% of patients with and without END, respectively). Only 15% of ENDs were due to intracranial haemorrhage. In multivariable analysis, a more proximal occlusion site (M2 [reference], distal M1: OR 2.1 [IC95% 1.1-4.1], proximal M1: OR 3.8 [1.6-9.1], ICA±M1/M2: OR 5.0 [2.6-9.6], basilar artery: OR 4.9 [1.1-4.1]; P <0.001) and a longer thrombus (<6mm [reference], [6-9mm[: OR 1.3 [IC95% 0.6-2.9], [9-12mm[: OR 1.8 [0.8-3.9] and ≥12mm: OR 2.7 [1.3-5.6]; P =0.036) were independently associated with END. END occurred in 33%, 19%, 14%, 7% and 27% of patients with ICA±M1/M2, M1 proximal, M1 distal, M2 and basilar artery, respectively, and in 8%, 10%, 14% et 23% of patients with thrombus length of <6, [6-9[, [9-12[ and ≥12mm, respectively. Conclusion: Our study suggests that thrombus location and length are strong predictors of END in minor strokes with LVO. This may help to select the best candidates for additional endovascular therapy.

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 The Incidence and Associated Factors of Early Neurological Deterioration After Thrombolysis

Stroke ◽  
2020 ◽  
Vol 51 (9) ◽  
pp. 2705-2714 ◽  
Author(s):  
Wai M. Yu ◽  
Azmil H. Abdul-Rahim ◽  
Alan C. Cameron ◽  
Janika Kõrv ◽  
Petr Sevcik ◽  
...  
Keyword(s):  
Associated Factors ◽  
Intravenous Thrombolysis ◽  
National Institutes Of Health ◽  
Neurological Deterioration ◽  
Real World Data ◽  
Logistic Regression Models ◽  
Early Neurological Deterioration ◽  
Small Patient ◽  
Ischemic Attack ◽  
Univariate Analyses

Background and purpose: Early neurological deterioration (END) after stroke onset may predict severe outcomes. Estimated rates of END after intravenous thrombolysis among small patient samples have been reported up to 29.8%. We studied the incidence and factors associated with END among patients following intravenous thrombolysis. Methods: We analyzed SITS-International Stroke Thrombolysis registry patients with known outcomes enrolled in 2010 to 2017. END was defined as an increase in National Institutes of Health Stroke Scale score ≥4 or death within 24 hours from baseline National Institutes of Health Stroke Scale. We determined the incidence of END and used logistic regression models to inspect its associated factors. We adjusted for variables found significant in univariate analyses ( P <0.05). Main outcomes were incidence of END, associated predictors of END, ordinal day-90 mRS, and day-90 mortality. Results: We excluded 53 539 patients and included 50 726 patients. The incidence of END was 3415/50 726 (6.7% [95% CI, 6.5%–7.0%]). Factors independently associated with END on multivariate analysis were intracerebral hemorrhage (OR, 3.23 [95% CI, 2.96–3.54], P <0.001), large vessel disease (LVD) with carotid stenosis (OR, 2.97 [95% CI, 2.45–3.61], P <0.001), other LVD (OR, 2.41 [95% CI, 2.03–2.88], P <0.001), and ischemic stroke versus transient ischemic attack (TIA)/stroke mimics (OR, 16.14 [95% CI, 3.99–65.3], P <0.001). END was associated with worse outcome on ordinal mRS: adjusted OR 2.48 (95% CI, 2.39–2.57, P <0.001) by day-90 compared with no END. The adjusted OR for day-90 mortality was 9.70 (95% CI, 8.36–11.26, P <0.001). Conclusions: The routinely observed rate of END reflected by real-world data is low, but END greatly increases risk of disability and mortality. Readily identifiable factors predict END and may help with understanding causal mechanisms to assist prevention of END.

Abstract T P65: Early Statin Intervention Can Reduce the Early Neurological Deterioration and Recurrence in Acute Lacunar Stroke

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Kazuki Fukuma
Keyword(s):  
Univariate Analysis ◽  
Patient Characteristics ◽  
National Institutes Of Health ◽  
Neurological Deterioration ◽  
Lacunar Infarction ◽  
Lacunar Stroke ◽  
Factors Associated ◽  
Randomized Controlled ◽  
Early Neurological Deterioration ◽  
Statin Dose

Background and Purpose: Some patients with lacunar infarction show clinical neurological deterioration within few days after the onset. However factors associated with progressive lacunar stroke are unclear. The aim of this study was to identify the factors related to early neurological deterioration and recurrence in acute lacunar stroke. Methods: We studied 277 consecutive patients (173 men; mean age, 72 years) with a lacunar infarction admitted within 72 hours after the onset between Jan 2011 and Jul 2013. Progressive infarction (PI) was defined as an increase of ≥ 4 points in the National Institutes of Health Stroke Scale (NIHSS) score or recurrence of symptomatic ischemic stroke within 30 days after the onset. Associations between PI and patient characteristics, neuroimaging and acute treatments were evaluated. Results: Twenty-four of the 277 patients (8.7%) had PI, 21 patients (7.6%) presented with neurological deterioration and remaining 3 (1.1%) with symptomatic recurrence. In univariate analysis, an initial infarct extent of ≥15 mm was more frequent (P < 0.01), and age (P = 0.04), CRP (P = 0.05) and LDL-C (P = 0.04) were higher in patients with PI than those without. Early statin intervention (newly initiated statin, dose-escalation of pre-treated statin, or switching to strong statin) was significantly more frequent in patient without PI (41.9 vs 20.8%, P=0.04). Early dual antiplatelet or anticoagulant therapy was not associated with PI. In multivariate analysis, age [OR: 1.67 per 10 year; 95% CI: 1.07-2.70, p = 0.02], an initial infarct extent of ≥15 mm [OR: 5.26; 95% CI: 2.01-14.37, p < 0.01], LDL-C [OR: 1.25 per 10mg/dL; 95% CI: 1.09-1.46, p < 0.01], and statin intervention [OR: 0.22; 95% CI: 0.06-0.68, p < 0.01] were related to PI. Conclusion: Older Age, higher LDL-C and larger initial infarct extent were related to early neurological deterioration and recurrence in acute lacunar stroke. Further, early statin intervention can reduce the progressive lacunar stroke. Prospective randomized controlled trials are needed to determine whether the early statin intervention can prevent progression in acute lacunar stroke.

scholarly journals Early administration of tirofiban after urokinase-mediated intravenous thrombolysis reduces early neurological deterioration in patients with branch atheromatous disease

2020 ◽  
Vol 48 (5) ◽  
pp. 030006052092629
Author(s):  
Bin Liu ◽  
Hong Zhang ◽  
Rong Wang ◽  
Hongdang Qu ◽  
Yifei Sun ◽  
...  
Keyword(s):  
Intravenous Thrombolysis ◽  
National Institutes Of Health ◽  
Neurological Deterioration ◽  
Control Group ◽  
Early Administration ◽  
Significant Difference ◽  
Early Neurological Deterioration ◽  
Branch Atheromatous Disease ◽  
Long Term Prognosis

Objectives To investigate the effects of early administration of tirofiban after intravenous thrombolysis on early neurological deterioration in patients with branch atheromatous disease. Methods We analyzed clinical data from patients with branch atheromatous disease. We enrolled seven cases into the urokinase-only (UO) control group and 10 cases into the urokinase + tirofiban (UT) treatment group. National Institutes of Health Stroke Scale (NIHSS) scores were obtained at admission and on days 3 and 5 after admission. Modified Rankin Scale (mRS) scores were obtained 3 months after admission. Results Significant differences between the UO and UT groups were evident on days 3 and 5 after admission. In the UT group, there was a significant difference between NIHSS scores at admission and on day 5, while there were no significant differences in scores in the UO group. The early neurological deterioration rates were not significantly different between the two groups. However, there were significant differences in these rates at 72 and 120 hours. Both the mRS scores and the prognoses at 3 months differed between the two groups. Conclusion Early administration of tirofiban after urokinase-mediated intravenous thrombolysis reduces early neurological deterioration and improves the long-term prognosis of patients with branch atheromatous disease.

Abstract TP21: Is Presence of Diabetes Mellitus a Key Prognostic Factor among Patients Receiving Endovascular Treatment for Acute Ischemic Stroke?

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Seong-Joon Lee ◽  
Yang-Ha Hwang ◽  
Ji Man Hong ◽  
Jin Wook Choi ◽  
Dong-Hun Kang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Logistic Regression Analysis ◽  
Multiple Logistic Regression Analysis ◽  
Univariate Analysis ◽  
Intravenous Thrombolysis ◽  
The Impact

Introduction: Given the recent positive endovascular therapy trials for acute ischemic stroke (AIS), this therapeutic strategy is now being increasingly incorporated into routine clinical practice. Identifying prognostic factors among AIS patients receiving endovascular revascularization treatments (ERT) in the real world could be important for clinicians and patients. While the impact of diabetes mellitus (DM) on IV thrombolytic outcomes after AIS has been extensively investigated, there is a paucity of data assessing effects of DM on ERT outcomes after AIS. We evaluated the impact of comorbid DM on ERT for AIS. Methods: From Jan 2011 to Feb 2016, patients with AIS who underwent ERT for cervicocephalic occlusions were consecutively enrolled into the Acute Stroke due to Intracranial Atherosclerotic occlusion and Neurointervention - Korean Retrospective (ASIAN KR) registry from 3 hospitals. Patients were excluded if onset to puncture time over 8 hours, in-hospital stroke, or unavailable 3-month mRS. DM was diagnosed if a patient had the history, or hemoglobin A1c on admission was over 6.5. Univariate analysis was performed to compare the characteristics between DM and non-DM population. Multiple logistic regression analysis was used to validate the effect of comorbid DM on 3 month outcomes. Results: Of 721 patients, 667 (93%) were finally included, with 233 DM patients and 434 non-DM patients. In the univariate analysis, comorbidity with hypertension (71.2% vs. 58.3%, p=0.001) and dyslipidemia (36.7% vs. 26.7%, p=0.012) were more frequent in the DM population. Periprocedural factors such as target vessels, intravenous thrombolysis, and final reperfusion grades did not differ. Good outcomes with mRS 0-2 were less frequent in the DM population (43.3% vs. 53.7%, p=0.011). In the logistic regression analysis adjusting age, male sex, initial NIHSS, premorbid mRS, hypertension history, atrial fibrillation, intravenous thrombolysis, onset to puncture time and successful reperfusion, DM was an independent predictor of poor outcomes (mRS 3-6; 1.933, 1.274-2.933, p=0.002). Conclusion: In patients receiving ERT for AIS due to cervicocephalic artery occlusions, the presence of DM as a comorbidity confers greater odds of a poor functional outcome.

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

2019 ◽  
Vol 14 (3) ◽  
pp. 306-309 ◽  
Author(s):  
Ying Zhou ◽  
Wansi Zhong ◽  
Anli Wang ◽  
Wanyun Huang ◽  
Shenqiang Yan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Cerebral Artery ◽  
Intravenous Thrombolysis ◽  
Neurological Deterioration ◽  
Terminal Branch ◽  
Stroke Patients ◽  
Lenticulostriate Arteries ◽  
Early Neurological Deterioration

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 = 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.

scholarly journals Endovascular Therapy versus Thrombolysis in Patients with Mild Strokes and Large Vessel Occlusions within the Anterior Circulation

2018 ◽  
Vol 7 (6) ◽  
pp. 431-438 ◽  
Author(s):  
Andreas Kastrup ◽  
Freimuth Brunner ◽  
Helmut Hildebrandt ◽  
Christian Roth ◽  
Michael Winterhalter ◽  
...  
Keyword(s):  
Intravenous Thrombolysis ◽  
Clinical Results ◽  
National Institutes Of Health ◽  
Large Vessel ◽  
Intracranial Hemorrhages ◽  
Anterior Circulation ◽  
Treatment Groups ◽  
Good Outcome ◽  
Discharge Rates

Background: In patients with large vessel occlusions, endovascular treatment (ET) has been shown to be superior to intravenous thrombolysis (IVT) in recent trials. However, it is currently unclear if patients with mild strokes also benefit from ET. Methods: We compared the discharge rates of good outcome (modified Rankin scale [mRS] ≤2), very good outcome (mRS 0–1), symptomatic intracranial hemorrhages (SICH), and infarct sizes in patients with mild strokes (admission National Institutes of Health Stroke Scale ≤10) and distal intracranial carotid artery, M1, and M2 occlusions during two time periods. Results: From 1/2008 to 10/2012 160 patients (mean age: 72 ± 12 years) were treated with IVT, and from 11/2012 to 11/2016 145 patients (mean age: 71 ± 13 years,) received ET with or without IVT. The clinical results were comparable between both treatment groups (59% after ET vs. 56% after IVT, p = 0.5 for an mRS 0–2) and (38% after ET vs. 32% after IVT, p = 0.3 for an mRS 0–1). In the subgroup of patients with an mRS ≤6, the early outcome did not differ significantly between ET and IVT either. The rates of SICH as well as the infarct sizes were not significantly different after ET compared with IVT. Conclusion: Compared with IVT, the routine use of ET did not significantly improve the early clinical or radiological outcome in patients with mild strokes and anterior circulation large vessel occlusions. Further randomized trials are urgently needed to determine the role of ET in this cohort.

scholarly journals Platelet-to-neutrophil Ratio after Intravenous Thrombolysis Predicts Unfavorable Outcomes in Acute Ischemic Stroke

2020 ◽  
Vol 17 (4) ◽  
pp. 411-419
Author(s):  
Mei-Qi Wang ◽  
Ying-Ying Sun ◽  
Yan Wang ◽  
Xiu-Li Yan ◽  
Hang Jin ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intravenous Thrombolysis ◽  
Final Analysis ◽  
Hemorrhagic Transformation ◽  
Neurological Deterioration ◽  
Receiver Operating Curve ◽  
Outcome Indicators ◽  
Early Neurological Deterioration ◽  
Delayed Neurological Deterioration

Background and Purpose: Platelet-to-neutrophil ratio (PNR) was suggested to be an independent protective predictor for 90-days outcomes in acute ischemic stroke (AIS) patients in previous studies. This study aims to investigate the association between PNR and outcomes of AIS in intravenous thrombolysis (IVT) group. Methods: Data on acute ischemic stroke patients who received intravenous thrombolysis from April 2015 to March 2019 were collected. We defined the PNR value at admission as pre-IVT PNR and after IVT within 24 h was defined as post-IVT PNR. Clinical outcome indicators included early neurological deterioration (END), hemorrhagic transformation (HT), delayed neurological deterioration (DND), and poor 3-month outcome (3m-mRS >2). Results: A total of 581 patients were enrolled in the final analysis. The age was 61(53-69) years, and 423(72.8%) were males. Post-IVT PNR was independently associated with hemorrhagic transformation (OR = 0.974; 95%CI = 0.956-0.992; P=0.006), early neurological deterioration (OR = 0.939; 95%CI = 0.913-0.966; P = 0.01), delayed neurological deterioration (OR = 0.949; 95%CI = 0.912- 0.988; P = 0.011), and poor outcome (OR = 0.962; 95%CI = 0.948-0.976; P<0.001). PNR level was identified as high (at the cut-off value or above) or low (below the cut-off value) according to receiver operating curve (ROC) analyses on each endpoint. Comparison of early neurological deterioration, hemorrhagic transformation, delayed neurological deterioration, and poor 3-month outcome (3m-mRS >2) between patients at high and low levels for platelet-to-neutrophil ratio (PNR) showed statistical differences (p<0.001). Conclusions: Post-IVT PNR was independently associated with early neurological deterioration, hemorrhagic transformation, delayed neurological deterioration, and poor 3-month outcome. Lower PNR can predict a worse outcome.

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