Intravenous Thrombolysis in Acute Ischemic Stroke: A Prognostic Prediction Model and the Role of Ischemic Core Growth Rate.

AIMS

The tissue window is increasingly recognized in guiding reperfusion therapy beyond the standard time window in acute ischemic stroke (AIS). This study aims to develop a nomogram incorporating an ischemic core growth rate index to provide individualized prediction of neurological outcomes in AIS patients who received intravenous thrombolysis (IVT).

METHODS

A retrospective study was conducted at the First Affiliated Hospital of Soochow University (2016-2023). A lasso-logistic method was employed for variable selection and model construction. The performance of the model was evaluated using the receiver operating characteristic curve, calibration curve, decision curve analysis, and compared with a conventional indexed one.

RESULTS

The study cohort comprised 553 patients with favorable outcomes (median ischemic core growth rate: 1.4 [0.5, 4.1] mL/h) and 198 patients with poor outcomes (median ischemic core growth rate: 5.7 [1.1, 14.2] mL/h). The nomogram included diabetes, TOAST classification, ischemic core growth rate, neutrophil count, direct bilirubin, and NIHSS score at admission. It achieved an AUC of 0.882 (95% CI: 0.855-0.908), outperforming the conventional indexed one. Calibration showed good agreement between predicted and observed outcomes (Hosmer-Lemeshow p = 0.851).

CONCLUSION

Ischemic core growth rate strongly correlates with neurological prognosis in AIS. This nomogram offers reliable predictions for IVT outcomes.