Current Neurovascular ResearchCurrent Neurovascular ResearchCurrent Neurovascular Research1567-20261875-5739Bentham Science64424910.2174/0115672026287986240104074006MedicineResearch ArticleRisk Factors and Prognosis of Early Neurological Deterioration after Bridging TherapyXieYijuinfo@benthamscience.netLiShengyuinfo@benthamscience.netLiuLiuyuinfo@benthamscience.netTangShitinginfo@benthamscience.netLiuYayuaninfo@benthamscience.netTanShuangquaninfo@benthamscience.netLiangZhijianinfo@benthamscience.netDepartment of Neurology, The First Affiliated Hospital of Guangxi Medical UniversityDepartment of Neurology, Wuming Hospital of Guangxi Medical UniversityDepartment of Neurology, The First Affiliated Hospital, Sun Yat-sen University01012024211253107012025Copyright ©; 2024, Bentham Science Publishers2024Bentham Science Publishershttps://journals.eco-vector.com/1567-2026/article/view/644249

Background:Early neurological deterioration (END) after bridging therapy (BT) of acute ischemic stroke (AIS) patients is associated with poor outcomes.

Objective:We aimed to study the incidence, risk factors and prognosis of END after BT.

Methods:From January to December 2021, the clinical data of AIS patients treated by BT (intravenous thrombolysis with alteplase prior to mechanical thrombectomy) from three comprehensive stroke centers were analyzed. Patients were divided into non-END group and END group according to whether they developed END within 72 hours of symptom onset. Modified Rankin scale (mRS) was used to assess the patient’s prognosis at 90 days, and favorable outcomes were defined as mRS≤2. The incidence of END was investigated, and binary logistic regression analysis was used to explore its associated factors.

Results:The incidence of END after BT was 33.67%. The eligible 90 patients included 29 cases in the END group and 61 cases in the non-END group. Multivariate Logistic regression analysis showed that increase of systolic blood pressure (SBP) (OR=1.026, 95%CI:1.001-1.051, p =0.043), higher level of blood glucose at admission (OR=1.389, 95%CI:1.092-1.176, p =0.007) and large artery atherosclerosis (LAA) subtype (OR=8.009, 95%CI:2.357-27.223, p =0.001) were independent risk factors of END. Compared with the non-END group, the END group had significantly lower rates of good outcomes (6.90% versus 65.57%, p =0.001) while higher rates of mortality (44.83% versus 4.92%, p =0.001).

Conclusion:It was found that the incidence of END after BT in AIS patients was 33.67%. An increase in SBP, higher glucose levels at admission, and LAA were independent risk factors of END that predicted a poor prognosis.

Early neurological deteriorationacute ischemic strokebridging therapyrisk factorsprognosissystolic blood pressure.Ois A, Martinez-Rodriguez JE, Munteis E, et al. Steno-occlusive arterial disease and early neurological deterioration in acute ischemic stroke. Cerebrovasc Dis 2008; 25(1-2): 151-6. doi: 10.1159/000113732 PMID: 18212520Liu YL, Yin HP, Qiu DH, et al. Multiple hypointense vessels on susceptibility-weighted imaging predict early neurological deterioration in acute ischaemic stroke patients with severe intracranial large artery stenosis or occlusion receiving intravenous thrombolysis. Stroke Vasc Neurol 2020; 5(4): 361-7. doi: 10.1136/svn-2020-000343 PMID: 32586972Fu J, Zhou Y, Li Q, et al. Perfusion changes of unexplained early neurological deterioration after reperfusion therapy. Transl Stroke Res 2020; 11(2): 195-203. doi: 10.1007/s12975-019-00723-w PMID: 31485869Li W, Ding J, Sui X, et al. Prognosis and risk factors for reocclusion after mechanical thrombectomy. Ann Clin Transl Neurol 2020; 7(4): 420-8. doi: 10.1002/acn3.50999 PMID: 32154677Seners P, Turc G, Oppenheim C, Baron JC. Incidence, causes and predictors of neurological deterioration occurring within 24 h following acute ischaemic stroke: A systematic review with pathophysiological implications. J Neurol Neurosurg Psychiatry 2015; 86(1): 87-94. doi: 10.1136/jnnp-2014-308327 PMID: 24970907He Y, Yang Q, Liu H, et al. Effect of blood pressure on early neurological deterioration of acute ischemic stroke patients with intravenous rt-PA thrombolysis may be mediated through oxidative stress induced blood-brain barrier disruption and AQP4 upregulation. J Stroke Cerebrovasc Dis 2020; 29(8): 104997. doi: 10.1016/j.jstrokecerebrovasdis.2020.104997 PMID: 32689627Kim JM, Moon J, Ahn SW, Shin HW, Jung KH, Park KY. The etiologies of early neurological deterioration after thrombolysis and risk factors of ischemia progression. J Stroke Cerebrovasc Dis 2016; 25(2): 383-8. doi: 10.1016/j.jstrokecerebrovasdis.2015.10.010 PMID: 26597264Huang ZX, Huang Y, Zeng J, et al. Admission glucose levels may increase the risk for early neurological deterioration in females with acute ischemic stroke. Front Neurol 2020; 11: 548892. doi: 10.3389/fneur.2020.548892 PMID: 33250841Tan C, Zhao L, Dai C, et al. Risk factors related to early neurological deterioration in lacunar stroke and its influence on functional outcome. Int J Stroke 2023; 18(6): 681-8. doi: 10.1177/17474930221145259 PMID: 36461792Shen H, Ma Q, Jiao L, et al. Prognosis and predictors of symptomatic intracranial hemorrhage after endovascular treatment of large vessel occlusion stroke. Front Neurol 2022; 12: 730940. doi: 10.3389/fneur.2021.730940 PMID: 35126278Correction to: Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: A guideline for healthcare professionals from the american heart association/american stroke association. Stroke 2019; 50(12): e440-1. PMID: 31765293Geng C, Li SD, Zhang DD, et al. Endovascular thrombectomy versus bridging thrombolysis: Real-world efficacy and safety analysis based on a nationwide registry study. J Am Heart Assoc 2021; 10(3): e018003. doi: 10.1161/JAHA.120.018003 PMID: 33496186Du H, Lei H, Ambler G, et al. Intravenous thrombolysis before mechanical thrombectomy for acute ischemic stroke: A meta-analysis. J Am Heart Assoc 2021; 10(23): e022303. doi: 10.1161/JAHA.121.022303 PMID: 34779235Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: A guideline for healthcare professionals from the american heart association/american stroke association. Stroke 2019; 50(12): e344-418. doi: 10.1161/STR.0000000000000211 PMID: 31662037Adams HP Jr, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of org 10172 in acute stroke treatment. Stroke 1993; 24(1): 35-41. doi: 10.1161/01.STR.24.1.35 PMID: 7678184Cui Y, Meng WH, Chen HS. Early neurological deterioration after intravenous thrombolysis of anterior vs posterior circulation stroke: A secondary analysis of INTRECIS. Sci Rep 2022; 12(1): 3163. doi: 10.1038/s41598-022-07095-6 PMID: 35210531Guo Y, Zhang S, Li M, et al. Leukoaraiosis and earlier neurological outcome after mechanical thrombectomy in acute ischemic stroke. J Neuroradiol 2020; 47(6): 428-32. doi: 10.1016/j.neurad.2019.10.005 PMID: 32035971Kim JM, Bae JH, Park KY, et al. Incidence and mechanism of early neurological deterioration after endovascular thrombectomy. J Neurol 2019; 266(3): 609-15. doi: 10.1007/s00415-018-09173-0 PMID: 30631916Zhang M, Xing P, Tang J, et al. Predictors and outcome of early neurological deterioration after endovascular thrombectomy: A secondary analysis of the DIRECT-MT trial. J Neurointerv Surg 2023; 15(e1): e9-e16. doi: 10.1136/neurintsurg-2022-018976 PMID: 35688618Liu H, Zhang Y, Fan H, Wen C. Risk factors and functional outcomes with early neurological deterioration after mechanical thrombectomy for acute large vessel occlusion stroke. J Neurol Surg B Skull Base 2022; 84(2): 183-91. PMID: 36895817Choi KH, Kim JM, Kim JH, et al. Optimal blood pressure after reperfusion therapy in patients with acute ischemic stroke. Sci Rep 2019; 9(1): 5681. doi: 10.1038/s41598-019-42240-8 PMID: 30952938Jafari M, Desai A, Damani R. Blood pressure management after mechanical thrombectomy in stroke patients. J Neurol Sci 2020; 418: 117140. doi: 10.1016/j.jns.2020.117140 PMID: 32961389Wu K, Yuan Z, Chen W, et al. A nomogram predicts early neurological deterioration after mechanical thrombectomy in patients with ischemic stroke. Front Neurol 2023; 14: 1255476. doi: 10.3389/fneur.2023.1255476 PMID: 37799278Vilionskis A, Gaigalaite V, Salasevicius L, Jatuzis D. Association between systolic blood pressure parameters and unexplained early neurological deterioration (UnND) in acute ischemic stroke patients treated with mechanical thrombectomy. Ther Adv Neurol Disord 2022; 15. doi: 10.1177/17562864221093524 PMID: 35747319Gentile M. Progressing neurological deficit secondary to acute ischemic stroke. A study on predictability, pathogenesis, and prognosis. Arch Neurol 1995; 670-5.Yang T, Hu Y, Pan X, et al. Interpretable machine learning model predicting early neurological deterioration in ischemic stroke patients treated with mechanical thrombectomy: A retrospective study. Brain Sci 2023; 13(4): 557. doi: 10.3390/brainsci13040557 PMID: 37190522Kamada H, Yu F, Nito C, Chan PH. Influence of hyperglycemia on oxidative stress and matrix metalloproteinase-9 activation after focal cerebral ischemia/reperfusion in rats: Relation to blood-brain barrier dysfunction. Stroke 2007; 38(3): 1044-9. doi: 10.1161/01.STR.0000258041.75739.cb PMID: 17272778Desilles JP, Syvannarath V, Ollivier V, et al. Exacerbation of thromboinflammation by hyperglycemia precipitates cerebral infarct growth and hemorrhagic transformation. Stroke 2017; 48(7): 1932-40. doi: 10.1161/STROKEAHA.117.017080 PMID: 28526762Bevers MB, Vaishnav NH, Pham L, Battey TWK, Kimberly WT. Hyperglycemia is associated with more severe cytotoxic injury after stroke. J Cereb Blood Flow Metab 2017; 37(7): 2577-83. doi: 10.1177/0271678X16671730 PMID: 27671250Nam KW, Kim TJ, Lee JS, et al. Neutrophil-to-lymphocyte ratio predicts early worsening in stroke due to large vessel disease. PLoS One 2019; 14(8): e0221597. doi: 10.1371/journal.pone.0221597 PMID: 31449547Li Z, Zhao L, Maimaitiming D, Wang H, Sun L, Xiong W. Efficacy and safety of bridging therapy and direct mechanical thrombectomy in large vessel occlusions: A meta-analysis. Chin Med J 2023; 136(17): 2119-21. doi: 10.1097/CM9.0000000000002272 PMID: 36805972Liu W, Zhao J, Liu H, et al. Safety and efficacy of direct thrombectomy versus bridging therapy in patients with acute ischemic stroke eligible for intravenous thrombolysis: A meta-analysis of randomized controlled trials. World Neurosurg 2023; 175: 113-121.e3. doi: 10.1016/j.wneu.2023.04.018 PMID: 37040841