# Intracranial and extracranial artery stenosis and clinical outcome of acute ischemic stroke patients receiving intravenous thrombolysis

## TL;DR

This study finds that artery narrowing in the brain or neck does not worsen immediate stroke outcomes but affects long-term recovery in patients treated with clot-busting drugs.

## Contribution

The study identifies intracranial/extracranial artery stenosis as an independent predictor of poor long-term outcomes after stroke thrombolysis.

## Key findings

- Intracranial/extracranial artery stenosis was not linked to early neurological deterioration or bleeding after stroke treatment.
- Baseline NIHSS score was a strong predictor of bleeding and poor outcomes after stroke treatment.
- Artery stenosis was independently associated with worse 90-day recovery in stroke patients receiving thrombolysis.

## Abstract

Intracranial and/or extracranial atherosclerotic stenosis is a common etiology of acute ischemic stroke (AIS). This study aimed to evaluate the impact of intracranial or extracranial atherosclerotic stenosis on early neurological deterioration (END), hemorrhagic transformation (HT) and 90-day clinical outcomes in patients receiving intravenous thrombolysis.

We retrospectively enrolled patients with AIS who received intravenous alteplase (0.9 mg/kg) at the First Affiliated Hospital of Kunming Medical University between February 2019 and August 2022. Data on demographics, stroke risk factors, laboratory results, and neuroimaging findings were collected. Atherosclerotic stenosis (AS) was defined as >50% intracranial or extracranial arteries. Logistic regression was performed to identify independent predictors of clinical outcomes. END was defined as an increase of ≥4 points in the National Institutes of Health Stroke Scale (NIHSS) score within 24 h after stroke onset. HT was defined as any newly detected intracranial hemorrhage on follow-up cranial CT performed within 7 days after symptom onset.

A total of 185 AIS patients receiving intravenous thrombolysis were included in this study, with 88 (47.6%) in the IEAS group and 97 (52.4%) in the non-stenosis group. There was no significant association between the incidence of END and the presence of IEAS. Multivariable regression analysis revealed that baseline NIHSS was an independent risk factor for HT (OR = 1.120, 95% CI 1.038–1.209, p = 0.003), 90-day poor clinical outcome (OR = 1.198, 95% CI 1.105–1.298, p = 0.001) and 90-day death (OR = 1.384, 95% CI 1.179–1.625, p = 0.001). Although IEAS was not significantly associated with the incidence of END or HT, it was significantly correlated with 90-day poor clinical outcome (OR = 1.350, 95% CI 1.108–1.644, p = 0.003).

In this cohort, IEAS was not associated with END or HT but emerged as an independent predictor of poor 90-day functional outcome after intravenous thrombolysis for AIS.