Corticospinal Tract Hypoperfusion Associated With Unexplained Early Neurological Deterioration After Intravenous Thrombolysis

Danfeng Zhang; Wansi Zhong; Luowei Chen; Chao Xu; Shenqiang Yan; Ying Zhou; Xiaodong Ma; Min Lou

doi:10.3389/fneur.2022.854915

Corticospinal Tract Hypoperfusion Associated With Unexplained Early Neurological Deterioration After Intravenous Thrombolysis

Front Neurol. 2022 Mar 28:13:854915. doi: 10.3389/fneur.2022.854915. eCollection 2022.

Authors

Danfeng Zhang^{1

2}, Wansi Zhong¹, Luowei Chen¹, Chao Xu³, Shenqiang Yan¹, Ying Zhou¹, Xiaodong Ma², Min Lou¹

Affiliations

¹ Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
² Department of Neurology, Haiyan People's Hospital, Zhejiang, China.
³ Department of Neurology, Zhejiang Provincial People's Hospital, Hangzhou, China.

Abstract

Background and purpose: Early neurological deterioration (END) occurs in 10% among patients with acute ischemic stroke (AIS) who are receiving intravenous thrombolysis (IVT). Over half of them have no straightforward causes, which is referred to as unexplained END. We aimed to explore whether the presence of baseline corticospinal tract (CST) hypoperfusion could predict the development of unexplained END at 24 h in patients with AIS after receiving IVT.

Methods: We retrospectively analyzed the clinical and imaging data from patients with AIS who received IVT. Unexplained END was defined as ≥ 2-point increase of National Institutes of Health Stroke Scale (NIHSS) from baseline to 24 h without straightforward causes. Hypoperfusion lesions involving CST and other cerebral areas were identified on perfusion maps.

Results: Among 807 patients, CST hypoperfusion and non-CST hypoperfusion occurred in 488 (60.5%) and 319 (39.5%) patients, respectively. Patients with CST hypoperfusion were more likely to have unexplained END compared with patients with non-CST hypoperfusion (16.6 vs. 2.8%, P < 0.001). Binary logistics regression analysis showed that CST hypoperfusion was independently associated with unexplained END after IVT (OR = 5.64; 95% CI: 2.699-11.785; P < 0.001) after adjusting for baseline NIHSS, onset to needle time, baseline hypoperfusion volume, atrial fibrillation, and hypertension.

Conclusions: Patients with CST hypoperfusion were more likely to suffer from unexplained END after IVT, implying potential mechanisms and potential prevention of unexplained END.

Keywords: acute ischemic stroke; computed tomography perfusion; corticospinal tract; intravenous thrombolysis; unexplained early neurological deterioration.