Neurol Sci. 2025 Dec 17;47(1):12. doi: 10.1007/s10072-025-08721-7.
ABSTRACT
PURPOSE: To assess the proportion of early neurological deterioration (END) in patients with minor stroke, its impact on 3-month clinical outcomes, and the influence of large vessel occlusion (LVO) location on END development.
METHODS: We analyzed patients from the CICAT Code Stroke Registry in Catalonia, Spain, between January 1, 2016, and December 31, 2021. Inclusion criteria were baseline NIHSS ≤ 5, treatment with intravenous thrombolysis (IVT) with or without endovascular treatment (EVT), and available acute vascular imaging. END was defined as an NIHSS increase of ≥ 4 points at 24-36 h post-treatment. Poor clinical outcome was defined as modified Rankin Scale (mRS) 3-6 at 3 months.
FINDINGS: A total of 1,380 patients were included (median age 71 [IQR 59-79] years; 59% male; median NIHSS 4 [IQR 3-5]). LVO was present in 282 patients (20.4%). END occurred in 73 patients (5.3%): 12.1% with LVO vs. 3.6% without LVO (p < 0.001). LVO was the strongest predictor of END (OR 3.73; 95% CI 2.30-6.06; p < 0.001), regardless of occlusion level. Poor 3-month outcome was observed in 74% of patients with END, compared to 26.8% without END (p < 0.001). END independently predicted poor outcome (OR 6.79; 95% CI 3.23-14.31).
CONCLUSIONS: In minor stroke patients treated with IVT or IVT + EVT, LVO was the primary driver of END even for mediun-sized arteries. END emerged as the strongest predictor of poor 3-month functional outcome.
PMID:41405770 | DOI:10.1007/s10072-025-08721-7