Neuroimaging Marker-CT Perfusion of Early Neurological Deterioration in Patients with Minor Stroke and Large Vessel Occlusion after Intravenous Thrombolysis

Hongli Zhang; Wanli Bao; Meiyan Yu; Xiang Li; Yongkun Gui; Hongkai Cui; Ping Zhang

doi:10.2174/0115672026306424240319101049

Neuroimaging Marker-CT Perfusion of Early Neurological Deterioration in Patients with Minor Stroke and Large Vessel Occlusion after Intravenous Thrombolysis

Curr Neurovasc Res. 2024 Apr 2. doi: 10.2174/0115672026306424240319101049. Online ahead of print.

Authors

Hongli Zhang¹, Wanli Bao¹, Meiyan Yu¹, Xiang Li¹, Yongkun Gui¹, Hongkai Cui¹, Ping Zhang¹

Affiliation

¹ Department of Neurology, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China.

PMID: 38571342
DOI: 10.2174/0115672026306424240319101049

Abstract

Objective: Early Neurological Deterioration (END) is one of the complications in Acute ischemic stroke (AIS) and relates to prognosis. However, the reason why it occurs is still unclear. Our study is to investigate if CT perfusion (CTP) can predict END in patients with Minor Stroke and Large Vessel Occlusion after Intravenous Thrombolysis (IVT).

Methods: Patients who underwent IVT with Large Vessel Occlusion were enrolled continuously from January 2021 to August 2023. After evaluating the National Institutes of Health Stroke Scale (NIHSS) score, they were divided into the END group (n=21) and the Non-END group (n=20). Multivariate logistic regression analysis was performed to explore the factors of END. Receiver-operating characteristic (ROC) curve analysis was also used to assess the discriminative ability of CTP in predicting END.

Results: A total of 41 patients (mean age, 62.34 ± 10.82 years, 27 male) were finally included in the analysis; 21 patients had END, and 9 patients underwent Endovascular thrombectomy (EVT). Multivariate logistic regression analysis indicated that rCBV (OR=0.081, 95%CI=0.009- 0.721, p = 0.024) and admission-NIHSS (OR=1.990, 95%CI=1.049-3.772, p = 0.035) were significantly associated with END. The area under the curve (AUC) of rCBV and NIHSS to discriminate END were 0.708 and 0.758. We found patients with END had a higher modified Rankin Scale (mRS) in 3 months.

Conclusions: The rCBV and NIHSS were associated with post-thrombolysis END and may become reliable markers to predicate END. END might predict a poor 3-month functional outcome.

Keywords: CT perfusion; Intravenous thrombolysis; NIHSS; early neurological deterioration; minor stroke..