Predictive factors for lack of neurological improvement in acute stroke patients without large vessel occlusion treated with low-dose thrombolysis and screened with 3T MRI.

Abstract

Objective: The study evaluated the lack of neurological improvement and the factors influencing it in patients with acute ischemic stroke (AIS) without major arterial occlusion.

Patients and methods: A cross-sectional study was conducted on patients diagnosed with acute ischemic stroke without significant occlusion of major arteries, with imaging evidence from 3-tesla magnetic resonance imaging (MRI) scans at the S.I.S Hospital in Can Tho, Vietnam, from 2019 to 2023. Eligible patients received treatment with low-dose alteplase (a single dose of 0.6 mg/kg).

Results: Among the 268 patients included in the study, a significant improvement in neurological function was observed in 195 patients (72.8%) [modified Rankin Scale (mRS): 0-1 points], while 73 patients (27.2%) demonstrated little or no improvement after 3 months of treatment. There were no recorded fatalities during the study period. Female patients accounted for 35.8% of the total sample. The average age of the participants was 62.9 years. The multivariate regression analysis identified several predictive factors associated with the risk of lack of improvement after 3 months, including advanced age, higher National Institute of Health Stroke Scale (NIHSS) scores, elevated blood glycemia levels (mmol/L), and elevated high-sensitive (hs) troponin I levels (ng/mL) (p < 0.05). Glycemia and hs troponin I levels were identified as biomarkers for predicting outcomes after ischemic stroke. No evidence was found linking sex, a history of chronic illness, and a lack of improvement.

Conclusions: Predicting prognostic factors for lack of neurological improvement will assist neurologists in developing personalized treatment plans for patients, reducing complications, and promoting patient recovery.