Associations between early ischemic brain changes and thrombolysis outcome in acute stroke patients

Abstract

Stroke is one of the leading causes of mortality and long-term disability on the planet. The gold standard of stroke treatment is thrombolytic therapy (TLT), it is time-dependent and at the same time can cause serious side effects, such as lethal hemorrhagic transformation. Therefore, patient selection based on neuroimaging data, such as early ischemic brain changes, is critical to avoid severe side effects. The aim of our study was to investigate the associations between the parameters of early ischemic brain changes and the short-term outcome of TLT. We enrolled 185 patients with acute stroke, who underwent TLT (mean age: 62.8±9.8 years, 120 men). We assessed such early ischemic brain changes as the sign of hyperdense artery, the presence of hypoattenuation of brain tissue, the volume of hypodense brain tissue. The ASPECTS scale was used to assess the severity of early ischemic changes on computed tomography (CT). We also collected clinical and demographic data of the patients, their vascular risk factors and comorbidities. In the group of patients with visible hypoattenuation of brain tissue, the proportion of symptomatic hemorrhagic transformations was significantly higher: 7 (7.5%) vs 1 (1.2%), p<0.001. According to the correlation analysis, the severity of early ischemic changes on CT according to the ASPECTS was associated with the severity of neurological deficit measured with the NIHSS scale (r=0.73, p<0.001), a lower level of daily activity according to the Barthel index (r=0.67, p<0.001) and a higher level of disability according to the mRS scale (r=0.67, p<0.001) at discharge. Early ischemic brain changes are a reliable predictor of hemorrhagic transformation and unfavorable outcome of thrombolytic therapy in patients with acute ischemic stroke.