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Influencing factors of early dramatic recovery of neurological function after intravenous thrombolysis in patients with branch atheromatous disease

Intravenous thrombolysis can significantly improve the neurological function of patients with acute ischemic stroke. However, the expected early dramatic recovery (EDR) of neurological function after thrombolysis is not achieved in some patients with branch atheromatous disease (BAD). Here we evalua...

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Autores principales: Meng, Yuanyuan, Zhao, Yanjun, Wang, Ruixia, Wen, Jiangshan, Tang, Tianping
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10174376/
https://www.ncbi.nlm.nih.gov/pubmed/37171349
http://dx.doi.org/10.1097/MD.0000000000033658
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author Meng, Yuanyuan
Zhao, Yanjun
Wang, Ruixia
Wen, Jiangshan
Tang, Tianping
author_facet Meng, Yuanyuan
Zhao, Yanjun
Wang, Ruixia
Wen, Jiangshan
Tang, Tianping
author_sort Meng, Yuanyuan
collection PubMed
description Intravenous thrombolysis can significantly improve the neurological function of patients with acute ischemic stroke. However, the expected early dramatic recovery (EDR) of neurological function after thrombolysis is not achieved in some patients with branch atheromatous disease (BAD). Here we evaluated the factors associated with EDR after thrombolysis in BAD patients. METHODS: We conducted a retrospective study on 580 consecutive BAD patients. All patients met the diagnostic criteria of BAD and received intravenous recombinant tissue-type plasminogen activator (rt-PA). EDR was defined when the improvement of National Institutes of Health Stroke Scale (NIHSS) score was >8 points within 2 or 24 hours after rt-PA, or the total NIHSS score was 0 or 1. The factors associated with EDR were analyzed with multivariate logistic regression analysis. RESULTS: Among 580 patients, the incidence of EDR was 35.2% (204 cases). Compared with patients without EDR, patients with EDR had lower incidence of diabetes (15.7% vs 29.3%, P < .001), lower NIHSS scores at 2 and 24 hours after rt-PA (P < .001), less cerebral hemorrhage (0% vs 5.3%, P = .001), and shorter onset to treatment time (OTT) (P < .001). Multivariate logistic regression analysis in propensity score-matched cohort showed that EDR was associated with OTT (adjusted OR = 0.994; 95% CI, 0.989–0.999) and NIHSS score after rt-PA (adjusted OR = 0.768; 95% CI, 0.663–0.890). Notably, diabetes (adjusted OR = 0.477, 95% CI, 0.234–0.972) was an independent factor related to EDR of neurological function in BAD patients. In the subgroup analysis, a lower incidence of diabetes (adjusted OR = 0.205, 95% CI: 0.059–0.714, P = .013) and a lower NIHSS score after thrombolysis in patients with paramedian pontine infarction (adjusted OR = 0.809, 95% CI: 0.656–0.997, P = .047) were significantly associated with EDR. CONCLUSION: Diabetes is not conducive to EDR of neurological function in patients with BAD, especially in patients with paramedian pontine infraction. Low NIHSS score and short OTT after thrombolysis may be closely related to EDR after intravenous thrombolysis.
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spelling pubmed-101743762023-05-12 Influencing factors of early dramatic recovery of neurological function after intravenous thrombolysis in patients with branch atheromatous disease Meng, Yuanyuan Zhao, Yanjun Wang, Ruixia Wen, Jiangshan Tang, Tianping Medicine (Baltimore) 5300 Intravenous thrombolysis can significantly improve the neurological function of patients with acute ischemic stroke. However, the expected early dramatic recovery (EDR) of neurological function after thrombolysis is not achieved in some patients with branch atheromatous disease (BAD). Here we evaluated the factors associated with EDR after thrombolysis in BAD patients. METHODS: We conducted a retrospective study on 580 consecutive BAD patients. All patients met the diagnostic criteria of BAD and received intravenous recombinant tissue-type plasminogen activator (rt-PA). EDR was defined when the improvement of National Institutes of Health Stroke Scale (NIHSS) score was >8 points within 2 or 24 hours after rt-PA, or the total NIHSS score was 0 or 1. The factors associated with EDR were analyzed with multivariate logistic regression analysis. RESULTS: Among 580 patients, the incidence of EDR was 35.2% (204 cases). Compared with patients without EDR, patients with EDR had lower incidence of diabetes (15.7% vs 29.3%, P < .001), lower NIHSS scores at 2 and 24 hours after rt-PA (P < .001), less cerebral hemorrhage (0% vs 5.3%, P = .001), and shorter onset to treatment time (OTT) (P < .001). Multivariate logistic regression analysis in propensity score-matched cohort showed that EDR was associated with OTT (adjusted OR = 0.994; 95% CI, 0.989–0.999) and NIHSS score after rt-PA (adjusted OR = 0.768; 95% CI, 0.663–0.890). Notably, diabetes (adjusted OR = 0.477, 95% CI, 0.234–0.972) was an independent factor related to EDR of neurological function in BAD patients. In the subgroup analysis, a lower incidence of diabetes (adjusted OR = 0.205, 95% CI: 0.059–0.714, P = .013) and a lower NIHSS score after thrombolysis in patients with paramedian pontine infarction (adjusted OR = 0.809, 95% CI: 0.656–0.997, P = .047) were significantly associated with EDR. CONCLUSION: Diabetes is not conducive to EDR of neurological function in patients with BAD, especially in patients with paramedian pontine infraction. Low NIHSS score and short OTT after thrombolysis may be closely related to EDR after intravenous thrombolysis. Lippincott Williams & Wilkins 2023-05-12 /pmc/articles/PMC10174376/ /pubmed/37171349 http://dx.doi.org/10.1097/MD.0000000000033658 Text en Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC) (https://creativecommons.org/licenses/by-nc/4.0/) , where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal.
spellingShingle 5300
Meng, Yuanyuan
Zhao, Yanjun
Wang, Ruixia
Wen, Jiangshan
Tang, Tianping
Influencing factors of early dramatic recovery of neurological function after intravenous thrombolysis in patients with branch atheromatous disease
title Influencing factors of early dramatic recovery of neurological function after intravenous thrombolysis in patients with branch atheromatous disease
title_full Influencing factors of early dramatic recovery of neurological function after intravenous thrombolysis in patients with branch atheromatous disease
title_fullStr Influencing factors of early dramatic recovery of neurological function after intravenous thrombolysis in patients with branch atheromatous disease
title_full_unstemmed Influencing factors of early dramatic recovery of neurological function after intravenous thrombolysis in patients with branch atheromatous disease
title_short Influencing factors of early dramatic recovery of neurological function after intravenous thrombolysis in patients with branch atheromatous disease
title_sort influencing factors of early dramatic recovery of neurological function after intravenous thrombolysis in patients with branch atheromatous disease
topic 5300
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10174376/
https://www.ncbi.nlm.nih.gov/pubmed/37171349
http://dx.doi.org/10.1097/MD.0000000000033658
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