Tóm tắt
Objective: To determine the rate of early neurological improvement (ENI) and identify factors associated with ENI in patients with acute ischemic stroke (AIS) treated with intravenous alteplase alone.
Methods: A prospective observational study of consecutive patients with AIS who received intravenous alteplase without endovascular thrombectomy at the Stroke Center, Bach Mai Hospital, from November 2024 to August 2025. ENI was defined as a reduction of ≥ 4 points in the National Institutes of Health Stroke Scale (NIHSS) score at 24 hours compared with baseline. Multivariable logistic regression adjusted for baseline stroke severity was used to identify factors independently associated with ENI.
Results: A total of 251 patients were included (mean age 66.6 ± 11.8 years; 64.9% male; median baseline NIHSS 7 [IQR 5-9]). The mean onset-to-needle and door-to-needle times were 172 ± 51 and 44 ± 16 minutes, respectively. ENI occurred in 128 patients (51.0%; 95% CI 44.8-57.1), and its frequency increased steeply with baseline severity (6.2%, 67.2%, and 93.9% for NIHSS < 6, 6-10, and > 10, respectively). After adjustment, age ≥ 80 years (aOR 0.14; 95% CI 0.04-0.48; p = 0.002) and pre-stroke disability (modified Rankin Scale [mRS] ≥ 2; aOR 0.29; 95% CI 0.14-0.63; p = 0.002) were independently associated with lower odds of ENI. Diabetes mellitus showed a non-significant trend toward lower odds of ENI (aOR 0.43; 95% CI 0.16-1.15; p = 0.094). Treatment within 3 hours was associated with ENI in univariable analysis but not after adjustment for baseline severity (aOR 1.44; 95% CI 0.70-2.96; p = 0.324).
Conclusion: About half of the patients treated with intravenous alteplase alone achieved ENI at 24 hours. ENI depended strongly on baseline stroke severity. Very old age and pre-stroke disability were independently associated with a lower likelihood of ENI and should be considered when ENI is used for early prognostication.
