Predictors Of Prognosis In Acute Ischemic Stroke Patients After Intravenous Thrombolysis

Backgrounds and ObjectivesThe most effective methods for acute ischemic stroke are intravenous thrombolysis to recanalize the occluded artery and reperfuse the ischemic brain tissue as soon as possible.Despite increasing acute However,the clinical outcome of ischemic stroke patient receiving intravenous thrombolytic therapy differs from each other.We aimed to determine whether the serum levels of neuron specific enolase,antiplatelet treatment before stroke onset and cerebral microbleed were associated with intracranial hemorrhage and functional outcome in acute ischemic stroke(AIS)patients after intravenous thrombolysis.MethodsWe analyzed the clinical data for subjects with AIS patients treated with intravenous recombinant tissue type plasminogen activator(rtPA)within 4.5 hours from symptom onset.The serum neuron specific enolase levels were tested at 24 hours after thrombolysis,and the cerebral microbleed was detected at baseline susceptibility weighted imaging(SWI)before thrombolysis.According to computer tomography(CT)or MRI imaging assessed at 24 hours after thrombolysis,patients were classified into intracranial hemorrhage(ICH)positive group and ICH negative group.According to the modified Rankin Scale(mRS)assessed at 90 days after stroke,patients were classified into favorable outcome group(mRS 0-1)and unfavorable outcome group(mRS 2-6).Clinical,laboratory and imaging data were compared between respective subgroups.ResultsNeuron specific enolase levels correlated with National Institutes of Health Stroke Scale score 24 h after rtPA bolus(R=0.342,p=0.005).Compared to the CMB negative group on the baseline MRI,patients in the CMB positive group were more inclined to be older(66.0±11.2 vs 60.1±9.9;p=0.013)and have a history of hypertension(75.0% vs 49.4%;p=0.019).Logistic regression analysis revealed that baseline CMB presence(OR=6.402,p=0.010)and recanalization at 24 hours after rtPA(OR=4.769,p=0.040)were independent predictors for ICH at 24 hours after rtPA treatment.Baseline NIHSS(OR= 0.575,p=0.000),NIHSS score at 24 hours after rtPA bolus(OR=0.662,p=0.008)rather than neuron specific enolase level(OR=0.229,p=0.091)were independent predictors for favorable outcome at 90 days after stroke.ConclusionsWe found that after treatment with intravenous rtPA therapy,lower serum neuron specific enolase levels were associated with favorable outcome,which may be confounded by the link to NIHSS score.Baseline CMB presence was an independent predictor for ICH at 24 hours after rtPA,but prior antiplatelet treatment did not affect the stroke outcome after treatment with intravenous rtPA therapy.