Risk Factors for Symptom Aggravation in Acute Ischemic Stroke Due to Anterior Circulation Large Vessel Occlusion

This study is designed to expound the risk factors for symptomatic exacerbation of acute ischemic stroke due to anterior circulation large vessel occlusion (AIS-AC-LVO), aiming to inform strategies for preventing disease progression.

Two hundred patients with AIS-AC-LVO were retrospectively analyzed. Baseline data included demographics, vascular risk factors, stroke subtype, admission NIHSS score, core infarct volume, blood pressure, serum lipid profile, homocysteine (Hcy), and neutrophil count. Perioperative variables comprised onset-to-door time (ODT), door-to-procedure time (DPT), intravenous thrombolysis, bridging therapy, occlusion site, anesthesia type, procedure duration, intraoperative rescue interventions, recanalization status, and postoperative sedative use. Patients were classified into exacerbated or nonexacerbated groups according to 7-day neurological outcomes. Univariate analysis, multivariate logistic regression, and receiver operating characteristic (ROC) curve analysis were conducted.

Baseline NIHSS score, LDL-C, Hcy, neutrophil count, ODT, procedure duration, core infarct volume, and recanalization rate differed significantly between groups ( P <0.05). Multivariate analysis identified elevated Hcy (OR=2.109, 95% CI: 1.499-2.965), prolonged ODT (OR=1.574, 95% CI: 1.181-2.098), longer procedure duration (OR=1.049, 95% CI: 1.014-1.085), and higher LDL-C (OR=5.398, 95% CI: 1.385-21.036) as independent predictors of symptom worsening. ROC analysis showed strong predictive performance for Hcy (AUC=0.866) and ODT (AUC=0.769) (both P <0.001).

Elevated Hcy, elevated LDL-C, and prolonged ODT and procedure duration independently predict short-term neurological deterioration.