Factors associated with early improvement after intravenous thrombolyti̇c treatment i̇n acute ischemi̇c stroke

Objective: The aim of this study was to determine the factors associated with early neurological improvement (ENI) in patients with acute ischemic stroke treated with intravenous recombinant tissue plasminogen activator (IV rt-PA) and to determine the relationship between outcome at initial control after stroke. Method: In this study, 377 patients diagnosed with acute ischemic stroke treated with IV rt-PA in Izmir Dokuz Eylul University Hospital from October 2018 were reviewed. Considering that the patient database used since 2010 has been used since 2010, data from patients treated with IV rt-PA since January 2010 were obtained. Demographic characteristics, medical history, vital signs and laboratory findings of the patients; radiological findings, cardiologic examinations and stroke characteristics were examined in detail. ENI was defined as an improvement in National Institutes of Health Stroke Scale (NIHSS) score of ≥4 points compared to the pretreatment score or an NIHSS score of 0 at 1 hour, 24 hours and 7 days after stroke. We assessed the outcomes at 1-3 and 3-6 months after treatment using the modified Rankin Scale (mRS) score, and mRS scores of 0–1 were defined as 'very good' outcomes, 0-2 'good outcome'. Results: 1 hour ENI 21.5%, 24 hours ENI 38% and 7 days ENI 52.7% was observed in of 377 patients included in the study. Patients with 1 hour ENI had higher baseline NIHSS scores (p=0.003) than those without. The ENI group had lower serum BUN levels at the time of admission (p=0.007). Additionally, the presence of cortical involvement on brain imaging was also lower in the ENI group (p=0.023). The presence of diabetes mellitus was more frequent in the non-ENI group (p=0.038). Time to thrombolytic treatment was >120 minutes in the non-ENI group (p=<0.001). Patients with 24 hours ENI had higher baseline NIHSS scores (p=0.003) and shorter in-hospital time (p=0,001) than those without. The ENI group had lower serum glucose, BUN, erythrocyte levels at the time of admission (p=0.005, p=0.020, p=0.041). Additionally, the presence of hyperdense artery sign, cortical involvement, parenchymal hematoma type 2 on brain imaging were also lower in the ENI group (p=0.026, p=<0.001, p=0.006). Time to thrombolytic treatment was >120 minutes in the non-ENI group (p=0.026). Patients with non-ENI had larger final infarct volume on MRI (p=<0,001). Patients with 7 days ENI had higher baseline NIHSS scores (p=0.022), shorter in-hospital time (p=<0.001) and lower hospital infection (p=<0.001) than those without. The ENI group had lower serum glucose levels at the time of admission (p=0.048). Additionally, the presence of cortical involvement and parenchymal hematoma type 2 on brain imaging, pleural effusion were lower in the ENI group (p=0.001, p=0.017, p=0.026). Time to thrombolytic treatment was >120 minutes in the non-ENI group (p=0.028). Patients with non-ENI had larger final infarct volume on MRI (p=<0,001). Finally, logistic regression analysis showed a significant relationship between serum BUN level, time to thrombolytic treatment, cortical involvement, baseline NIHSS and 1 hour ENI. Logistic regression analysis showed a significant relationship between serum BUN level, final infarct volume on MRI, baseline NIHSS and 24 hours ENI. Logistic regression analysis showed a significant relationship between serum glucose levels at the time of admission, final infarct volume on MRI, baseline NIHSS and 7 days ENI. Conclusion: There is a significant relationship between 24 hours-7 days ENI and good-very good outcome at 1-3 and 3-6 months in acute stroke patients who received IV rt-PA. Therefore, the management of factors such as serum glucose, BUN and erythrocyte level, NIHSS score, presence of hyperdense artery sign on admission brain imaging and cortical involvement on brain imaging at 24 h, days in hospital, time to thrombolytic treatment and having diabetes mellitus which are related to ENI; and the determination of treatment strategies according to them are important issues for achieving a better outcome in acute ischemic stroke and might help to rapidly select patients who will not respond to IV rt-PA but who could be candidates for bridging therapy.