Early neurological deterioration in acute ischemic stroke: A propensity score analysis

To investigate whether endovascular therapy (EVT) was one of the factors influencing the incidence of early neurological deterioration (END) in patients with acute ischemic stroke (AIS) as compared with intravenous thrombolysis alone.

This study was based on our single-center's database that included information on stroke patients hospitalised between January 2012 and September 2015. A total of 220 patients who underwent EVT after IV rt-PA, EVT or IV rt-PA alone. To reduce the lack of randomization, we conducted a propensity score analysis using the SPSS custom dialog. After matching was completed, the 2 groups (with END versus non-END) were compared between matched groups. Variables with a p value ≤ 0.1 by univariate analysis were candidates for inclusion in logistic regression analysis.

Of 220 acute ischemic strokes attended, 213 patients were included (62.0%, 23.0% and 15.0% with circulation occlusion in the anterior, posterior and both branches, respectively). END was detected in 68 patients (31.9%). Multivariable analysis showed that END was positively associated with glucose level (OR, 1.40; 95%CI, 1.10-1.79; p = 0.007), uric acid level (OR, 1.01; 95% CI, 1.00-1.02; p = 0.026) and treatment methods (EVT: OR, 3.87; 95% CI, 1.32-11.35; p = 0.014). However, there was significant difference in baseline data (NIHSS and INR) between EVT group and non-EVT group.

Our findings suggest that hyperglycemia, hyperuricemia and EVT may be independently associated with END in AIS, even after controlling for possible confound factors. Further studies are warranted to confirm these results.