Risk Factors, Incidence Rates of Early Neurological Deterioration in 2 Stroke Types

Medical illustration of a brain with stroke symptoms
Researchers sought to compare post-thrombolytic early neurological deterioration between anterior circulation stroke and posterior circulation stroke based on data from the INTRECIS study.

Risk factors, not incidence rates, for post-thrombolytic early neurological deterioration (END) differed significantly between patients with anterior circulation stroke (ACS) and posterior circulation stroke (PCS), according to a prospective nationwide cohort study published in Scientific Reports.

ACS and PCS have been associated with differing etiologies, symptoms, and risk factors. Both patient groups are at risk for END within 24 hours of stroke, however, occurrence of END has not been investigated thoroughly and incidence rates and risk factors remain poorly understood.

The objective of the current study was to compare post-thrombolytic END between ACS and PCS based on data from the INtravenous Trombolysis REgistry for Chinese Ischaemic Stroke within 4.5 h of onset (INTRECIS) study.

The study recruited all adults (N=1194) with confirmed acute ischemic stroke who received treatment within 4.5 hours after stroke onset between 2017 and 2019 in China. Patients were stratified into ACS (n=942) and PCS (n=252) cohorts and assessed for onset of and risk factors for END.

The ACS and PCS cohorts were aged median 64 (interquartile range [IQR], 56-72) and 62 (IQR, 55-70) years, 67.9% and 65.1% were men, body mass index (BMI) was 23.8 (IQR, 21.1-26.1) and 24.5 (IQR, 22.0-27.1) kg/m2, blood glucose was 6.80 (IQR, 5.80-8.60) and 7.30 (IQR, 6.12-10.00) mmol/L (P =.001), 51.6% and 65.9% had hypertension (P =0.000), 16.2% and 27.4% diabetes mellitus (P =0.000), 10.6% and 5.6% atrial fibrillation (P =.015), and onset to thrombolysis time was 165 (IQR, 125-206) and 179 (IQR, 143-216) minutes (P =.016), respectively.

END occurred among 4.1% of patients. The incidence rate was similar among the ACS (3.8%) and PCS (5.2%) cohorts (odds ratio [OR], 0.750; 95% CI, 0.381-1.477; P =.406).

Among the ACS cohort, risk factors for END were atrial fibrillation (OR, 3.657; 95% CI, 1.323–10.107; P =.012) and Trial of Org 10,172 in Acute Stroke Treatment (TOAST) classification (OR, 1.703; 95% CI, 1.142–2.538; P =.009). For the PCS group, hypertension history (OR, 11.298; 95% CI, 1.043–122.409; P =.046) and National Institutes of Health Stroke Scale (NIHSS) score (OR, 1.099; 95% CI, 1.021–1.182; P =.011) were predictors.

END was associated with poorer functional outcomes among both the ACS (OR, 2.301; 95% CI, 1.685–2.917; P <.001) and PCS (OR, 3.314; 95% CI, 2.132–4.496; P <.001) cohorts.

This study may have been limited by the low number of patients with END, causing power to be limited.

“The current study provided the first report about END after intravenous thrombolysis in patients with ACS vs PCS, and found similar incidence, but different risk factors of END in the two distinct types of stroke,” the researchers concluded.


Ciu Y, Meng W-H, Chen H-S. Early neurological deterioration after intravenous thrombolysis of anterior vs posterior circulation stroke: a secondary analysis of INTRECIS. Sci Rep. Published online February 24, 2022. doi:10.1038/s41598-022-07095-6