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.

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.