Outcome of ischemic stroke patients with serious post-thrombolysis neurological deficits

To identify factors associated with favorable outcome in ischemic stroke patients having considerable post-thrombolytic neurological deficits but without endovascular treatment.

We registered 1427 consecutive thrombolysis-treated ischemic stroke patients, of which 473 (33%) had ≥8 NIH Stroke Scale (NIHSS) points after thrombolysis but did not undergo any further rescue intervention. We dichotomized them based on 3-month modified Rankin Scale (mRS) to those with favorable (mRS 0-2, n = 126, 27%) and unfavorable (mRS 3-6, n = 347) outcome. Univariate and multivariable methods tested associations of baseline and post-thrombolysis parameters with outcome.

Lower post-thrombolysis NIHSS score and younger age had strongest association with favorable outcome. Most of patients with post-thrombolytic NIHSS score ≥11 achieved unfavorable outcome. In contrast, half of patients with favorable outcome had post-thrombolytic NIHSS≤10, and 62% of patients younger than 75 years and having post-thrombolytic NIHSS 8-9 achieved favorable outcome. Weaker independent association was observed for blood glucose level and baseline diastolic blood pressure.

As expected, NIHSS score and patient age showed the strongest association with final outcome in a subpopulation of patients having considerable post-thrombolytic neurological deficit. A relatively high proportion of patients with post-thrombolytic NIHSS 8-9 (10) achieved a favorable 3-month outcome without any further intervention.