• Di Hu, Lizhi Yu, Biao Feng, Qianqian Tang, Fang Wen, Ting Jia, and Chengcai Xia.
• Department of Neurology, Nanjing Pukou People's Hospital, Nanjing, China.
• World Neurosurg. 2025 Jan 20; 194: 123623123623.

ObjectiveEarly identification of risk factors associated with early neurological deterioration (END) in patients with acute minor stroke and large vessel occlusion (LVO) receiving intravenous thrombolysis (IVT) could assist in formulating treatment decisions.MethodsConsecutive patients with acute minor stroke and LVO were extracted from a single-center prospective database spanning from January 2020 to December 2023. END was defined as an increase of ≥4 points in the National Institutes of Health Stroke Scale score from baseline or ≥2 points in any single National Institutes of Health Stroke Scale item, within 24 hours of IVT. Multivariate logistic regression analysis, adjusted for confounding variables, was employed to identify risk factors associated with END.ResultsA total of 163 patients were included in this study, of which 36 (22.1%) patients encountered END. Patients in the END group had a higher proportion of isolated internal carotid artery (ICA) occlusion (30.6% vs. 6.3%), delayed antiplatelet therapy (88.9% vs. 66.1%), and a larger Tmax > 4 seconds volume (142 vs. 114 mL) (all P < 0.05). Multivariate logistic regression analysis after adjusting for confounding factors showed that isolated (ICA) occlusion (adjusted odds ratio = 2.49, 95% confidence interval = 1.97-4.41; P < 0.001) and delayed antiplatelet therapy (adjusted odds ratio = 1.46, 95% confidence interval = 1.17-1.84; P < 0.001) were significantly associated with END.ConclusionsIsolated ICA occlusion and delayed antiplatelet therapy were significantly associated with END in minor stroke patients with LVO following IVT. Bridging thrombectomy and early administration of antiplatelet therapy may be considered reasonable strategies.Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.

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