Early neurological deterioration in acute ischemic minor stroke patients with large vessel occlusion following intravenous thrombolysis

Objective: Early identification of risk factors associated with early neurological deterioration (END) in patients with acute minor stroke and large vessel occlusion (LVO) receiving intravenous thrombolysis (IVT) could assist in formulating treatment decisions.

Methods: Consecutive patients with acute minor stroke and LVO were extracted from a single-center prospective database spanning January 2020 to December 2023. END was defined as an increase of ≥ 4 points in the National Institutes of Health Stroke Scale (NIHSS) score from baseline, or ≥ 2 points in any single NIHSS item, within 24 hours of the IVT. Multivariate logistic regression analysis, adjusted for confounding variables, was employed to identify risk factors associated with END.

Results: A total of 163 patients were included in this study, of which 36 (22.1%) patients encountered END. Patients in the END group had a higher proportion of isolated internal carotid artery (ICA) occlusion (30.6% vs. 6.3%), delayed antiplatelet therapy (88.9% vs. 66.1%), and a larger Tmax > 4s volume (142 vs. 114 ml) (all P < 0.05). Multivariate logistic regression analysis after adjusting for confounding factors showed that isolated (ICA) occlusion (adjusted odds ratio [aOR] = 2.49, 95% confidence interval [CI] = 1.97-4.41; P < 0.001) and delayed antiplatelet therapy (aOR = 1.46, 95% CI = 1.17-1.84; P < 0.001) were significantly associated with END.

Conclusions: Isolated ICA occlusion and delayed antiplatelet therapy were significantly associated with END in minor stroke patients with LVO following IVT. Bridging thrombectomy or early administration of antiplatelet therapy may be considered reasonable strategies.