Tenecteplase combined with nicergoline improves neurological, endothelial function and short-term prognosis in AACI...

To explore the efficacy of tenecteplase combined with nicergoline in acute atherosclerotic cerebral infarction (AACI), and screen risk indicators for poor prognosis.

A total of 368 AACI patients were enrolled and randomly allocated into a training set (n=258) and a validation set (n=110) at a 7:3 ratio. Each set was subdivided into control group (tenecteplase thrombolysis + basic treatment) and combination group (additional oral nicergoline for 14 days). National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), serum nitric oxide (NO), and endothelin-1 (ET-1) were measured before and after treatment. Patients were followed up for 3 months to record mRS, prognosis and adverse events. Independent risk factors were screened by multivariate logistic regression, a nomogram was constructed, and its predictive efficiency was evaluated by receiver operating characteristic (ROC) curve analysis.

No significant baseline differences were observed between the two treatment groups within the training set (P>0.05). After treatment, in the training set, the combination group had lower NIHSS score, ET-1 level, 3-month poor prognosis rate, mRS score and adverse event incidence, with higher BI and NO levels than the control group (all P<0.05). An NIHSS ≥3.5, BI <76.5, ET-1 ≥57.34 ng/L and NO <49.29 μmol/L were identified as independent risk factors for poor prognosis. The nomogram demonstrated good calibration in both cohorts. ROC curve analysis showed that the combined model incorporating all 4 indicators had superior predictive performance compared with any single index in both cohorts.

Tenecteplase combined with nicergoline can improve neurological and vascular endothelial function, reduce adverse events, and improve short-term prognosis of AACI patients. The 4 indicators are independent predictors for poor prognosis, with better efficiency in combined detection.