Predictors of Early versus Delayed Neurological Deterioration after Thrombolysis for Ischemic Stroke

被引：4

作者：

Han, Qiao ^{[1
,2
]}

You, Shoujiang ^{[1
,3
]}

Maeda, Toshiki ^{[3
,4
]}

Wang, Yanan ^{[5
]}

Ouyang, Menglu ^{[3
]}

Li, Qiang ^{[3
]}

Song, Lili ^{[3
,6
]}

Zhao, Yang ^{[3
,6
]}

Ren, Xinwen

Chen, Chen ^{[3
,7
]}

Delcourt, Candice ^{[3
,8
]}

Zhou, Zien ^{[3
]}

Cao, Yongjun ^{[1
]}

Liu, Chun-Feng ^{[1
]}

Zheng, Danni ^{[3
]}

Arima, Hisatomi ^{[4
]}

Robinson, Thompson G. ^{[9
,10
]}

Chen, Xiaoying ^{[3
]}

Lindley, Richard I. ^{[3
,11
]}

Chalmers, John ^{[3
]}

Anderson, Craig S. ^{[3
,6
,12
]}

Wang, Xia

机构：

[1] SooChow Univ, Affiliated Hosp 2, Clin Res Ctr Neurol Dis, Dept Neurol, Suzhou, Peoples R China

[2] Nanjing Univ Chinese Med, Suzhou TCM Hosp, Dept Neurol, Suzhou, Peoples R China

[3] Univ New South Wales, George Inst Global Hlth, Fac Med, Sydney, NSW, Australia

[4] Fukuoka Univ, Fac Med, Dept Prevent Med & Publ Hlth, Fukuoka, Japan

[5] Sichuan Univ, West China Hosp, Dept Neurol, Chengdu, Peoples R China

[6] George Inst Global Hlth China, Beijing, Peoples R China

[7] Tongji Univ, Shanghai East Hosp, Sch Med, Dept Neurol, Shanghai, Peoples R China

[8] Macquarie Univ, Fac Med Hlth & Human Sci, Dept Clin Med, Sydney, NSW, Australia

[9] Univ Leiceste, Dept Cardiovasc Sci, Leicester, England

[10] Univ Leicester, NIHR Leicester Biomed Res Ctr, Leicester, England

[11] Univ Sydney, Westmead Clin Sch, Sydney, NSW, Australia

[12] Royal Prince Alfred Hosp, Neurol Dept, Sydney, NSW, Australia

来源：

CEREBROVASCULAR DISEASES | 2025年 / 54卷 / 02期

基金：

英国医学研究理事会;

关键词：

Ischemic stroke; Thrombolysis; Neurological deterioration; Prediction; ENCHANTED; BLOOD-PRESSURE VARIABILITY; INTRAVENOUS ALTEPLASE; ENHANCED CONTROL; HYPERTENSION; THROMBECTOMY; GUIDELINES; DEPENDS; EDEMA;

D O I：

10.1159/000539322

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Introduction: We aimed to determine predictors of early (END) and delayed neurological deterioration (DND) and their association with the functional outcome in patients with acute ischemic stroke (AIS) who participated in the international Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED). Methods: END and DND (without END) were defined as scores of a >= 2-point increase on the National Institutes of Health Stroke Scale (NIHSS) or a >= 1-point decrease on the Glasgow coma scale or death, from baseline to 24 h and 24-72 h, respectively. Multivariable logistic regression models were used to determine independent predictors of END and DND and their association with 90-day outcomes (dichotomous scores on the modified Rankin scale [mRS] of 2-6 vs. 0-1 and 3-6 vs. 0-2 and death). Results: Of 4,496 patients, 871 (19.4%) and 302 (8.4%) patients experienced END and DND, respectively. Higher baseline NIHSS score, older age, large-artery occlusion due to significant atheroma, cardioembolic stroke subtype, hemorrhagic infarction and parenchymatous hematoma within 24 h were all independent predictors for both END (all p <= 0.01) and DND (all p <= 0.024). Moreover, higher baseline systolic blood pressure (BP) (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.02-1.12), higher diastolic BP variability within 24 h (OR 1.07, 95% CI 1.04-1.09), patients from Asia (OR 1.25, 95% CI 1.03-1.52) were the only independent predictors for END. However, Asian ethnicity was negatively associated with DND (OR 0.64, 95% CI 0.47-0.86). Hemorrhagic infarction and parenchymatous hematoma within 24 h were the key predictors of END across all stroke subtypes. END and DND were all associated with a poor functional outcome at 90 days (all p < 0.001). Conclusion: We identified overlapping and unique demographic and clinical predictors of END and DND after thrombolysis for AIS. Both END and DND predict unfavorable outcomes at 90 days.

引用

页码：175 / 183

页数：9

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