Clinical Study Of Early Neurological Deterioration After Intravenous Thrombolysis In Mild Strokes With Anterior Circulation Large Vessel Occlusion

Objectives: 1.To observe the incidence,time of occurrence,symptoms and clinical features of early neurological deterioration after intravenous thrombolysis in mild strokes with anterior circulation large vessel occlusion,and to analyze relevant influencing factors.2.Assess the predictive value of ABCD3-I score for early neurological deterioration in such patients.Methods: We collected retrospectively patients with mild stroke(NIHSS score≤5)with anterior circulation and large vessel occlusion(LVO)who were admitted to the Department of Neurology,First Affiliated Hospital of Dalian Medical University,from January 2015 to December 2020,and treated with intravenous thrombolysis.All general clinical data,past medical history,related laboratory indicators,imaging data,bleeding transformation during hospitalization and 90 day follow-up were collected,and all patients were scored according to the ABCD3-I scoring method and the scores were recorded.We focused on the incidence,time of occurrence,symptoms and clinical characteristics of all patients with early neurological deterioration(END).All patients were divided into END group and non-END group according to whether END occurred.Univariate and multivariate logistic regression analysis was used to analyze the occurrence of END influencing factors.Patients in group END were divided into mechanical thrombectomy group,argatroban anticoagulant group and double antiplatelet group according to different combined remedy measures after intravenous thrombolysis.The 90-day prognosis of the three groups was analyzed,and the modified Rankin scale(m RS)was used to evaluate the 90 day prognosis.In addition,by drawing the receiver operating characteristic curve(ROC)of the ABCD3-I score,and calculating the area under the curve(AUC),the predictive value of the ABCD3-I score on END was analyzed.All data were analyzed by SPSS26.0 statistical software,and P<0.05 was considered statistically significant.Results:1.A total of 120 mild stroke patients with anterior circulation LVO were included in this study.Among them,23.3%(28/120)had END.The time from admission to END was 9.0(2.5～24)h,and 46.4%(13/28)had END within 6 h.The NIHSS score of neurological deterioration increased by 4(4～5).Most of the clinical symptoms of deterioration were new limb weakness or worsening of the original limb weakness(96.4%,27/28),followed by disturbance of consciousness(32.1%,9/28),28.6% of new language barriers or worsening of existing language barriers(8/28),new sensory disturbances or aggravating of original sensory disturbances,new central facial/tongue paralysis,and gaze appears accounted for 10.7%(3/28),10.7%(3/28)and 7.1%(2/28)respectively.2.Comparing the clinical data between the END group and the no END group,the level of fibrinogen(Fib),the prevalence of diabetes and the proportion of M1 occlusion in the large vessel occlusion of the END group were significantly higher than those of the no END group [3.06(2.73,3.32)vs2.69(2.35,3.20),57.1%vs27.1%,53.6%vs28.3%,all P<0.05],multivariate logistic regression analysis showed diabetes(0R=4.633,95%CI: 1.821～11.788,P=0.001)and M1 segment occlusion(0R=3.069,95%CI:1.205～7.819,P=0.019)are independent factors influencing the occurrence of END after intravenous thrombolysis in mild stroke patients with anterior circulation LVO.3.The NIHSS score of the END group at discharge was significantly higher than that of the no END group [5.0(3.0,7.0)vs1.0(0,2.75),P=0.000].In terms of discharge ways,60.7% of patients in END group went to rehabilitation hospital for further treatment,which was significantly higher than 19.6% in no END group(P=0.033).At 90 days,the good prognosis of the END group was 53.6%(m RS 0～1 points),which was significantly lower than the 75.0% of the no END group(P=0.030),there was no difference in the conversion rate of intracranial hemorrhage between the two groups(7.1%vs6.5%,P=0.908),and both were asymptomatic intracranial hemorrhage,there was also no significant difference in the proportion of oral and gum bleeding between the two groups(7.1%vs7.6%,P=0.935),and all were small amounts of bleeding that could be controlled after compression.There was no death in all patients within 90 days of follow-up.4.Among the 28 patients with END,3 patients(10.7%)received mechanical thrombectomy after thrombolysis,7 patients(21.4%)combined with argatroban anticoagulant therapy,and 18 patients(67.9%)only received antiplatelet therapy.There was no significant difference in baseline NIHSS score and discharge NIHSS score between the three groups(all P>0.05),the proportion of good prognosis(m RS 0～1)of the three groups was anticoagulation group(85.7%)> thrombectomy group(66.7%)>double antiplatelet group(38.9%).5.The incidence of END in the high-risk group with the ABCD3-I scoring method was significantly higher than that in the middle-risk group(52.1%vs4.2%,P=0.000).The ABCD3-I score predicts the AUC of END is 0.891(0.829～0.953),P=0.000,the best cut-off value is 7.5,the sensitivity is 0.893,and the specificity is 0.750.Conclusions:1.23.3% of mild stroke patients with anterior circulation LVO developed END after intravenous thrombolysis,most of the worsening clinical symptoms were newly appeared limb weakness or worsening of the original limb weakness,and diabetes and M1 occlusion are independent factors influencing the occurrence of END.2.The clinical prognosis of the END group was worse than that of the no END group,more patients needed to continue rehabilitation,after the occurrence of END,the combination of argatroban anticoagulation and mechanical thrombectomy treatment improved the prognosis of 90 days better than double antiplatelet treatment.3.The ABCD3-I score has a good predictive value for the occurrence of END after intravenous thrombolysis in mild stroke patients with anterior circulation LVO,and it is worthy of clinical application.