Risks for early neurological deterioration after thrombolytic therapy in patients with acute ischemic stroke

Abstract

Background: Early neurological deterioration (END) is a common complication following intravenous thrombolysis in acute ischemic stroke (AIS). This study aimed to identify factors associated with END to improve early risk stratification and management.

Methods: We conducted a prospective observational study including AIS patients treated with intravenous recombinant tissue plasminogen activator (rt-PA) within 4.5 hours of symptom onset. END was defined as an increase of ≥ 4 points in the NIHSS score within 24 hours after thrombolysis. Baseline data included demographics, vascular risk factors, prior medication use, NIHSS score, onset-to-needle and onset-to-thrombectomy times, laboratory markers (including inflammatory cytokines and platelet function), and neuroimaging findings. Univariate and multivariate logistic regression analyses were performed, and model performance was evaluated using receiver operating characteristic (ROC) curves.

Results: Among 300 enrolled patients, 66 (22.0%) developed END. Multivariate analysis identified higher NIHSS score at admission (P=0.011), longer onset-to-needle time (P=0.007), proximal large vessel occlusion (P=0.010), diabetes (P=0.018), elevated interleukin-6 (IL-6) levels (P<0.001), and increased maximum aggregation rate induced by arachidonic acid (MAR_AA) (P<0.001) as independent predictors of END. A predictive model incorporating these factors demonstrated excellent discriminative ability (AUC=0.873; 95% CI: 0.844–0.902).

Conclusion: Neurological severity, treatment delay, metabolic vulnerability, inflammation, and platelet hyperreactivity collectively contribute to END after thrombolysis. Identifying high-risk patients through clinical and biomarker profiling may help improve outcomes through early intervention.