Predictive Factors for Early Neurological Deterioration after intravenous thrombolysis of Single Small Subcortical Infarction in the Territory of the Middle Cerebral Artery

Abstract Background Patients with single subcortical infarction (SSI) in the middle cerebral artery (MCA) will often suffer from early neurological deterioration (END) despite receiving intravenous thrombolytic therapy (IVT). In this study, the predictors for END were studied in patients with single subcortical infarction in the MCA after IVT. Methods Patients with SSIs in the territory of the middle cerebral artery with IVT between June 2020 and June 2022 were included in this study. END was defined as an ≥ 2 increase in the total National Institutes of Health Stroke Scale (NIHSS) score or ≥ 1 in the motor NIHSS score within the first 72 hours of admission. In addition to the analysis of the predictors of END in SSI patients who received IVT in the territory of MCA, proximal and distal SSI patients were also analyzed. Results A total of 174 patients with SSI in the territory of the MCA who received IVT were evaluated. In multivariable logistic regression analysis, the presence of pSSI (odds ratio, 5.98;95% CI, 2.13–16.78; P = 0.001), lower TT (odds ratio, 0.694; 95% CI, 0.511 ~ 0.943; P = 0.019), and higher red blood cells (odds ratio,2.047; 95% CI, 1.120 ~ 3.741; P = 0.020) were positively associated with END in patients with proximal SSI (pSSI). In patients with pSSI, there was a positive correlation between AST and blood sugar. Meanwhile, no variable related to END was found in the distal SSI (dSSI) group. Conclusions The presence of pSSI, lower TT, and higher red blood cells are associated with END in patients with SSI in the territory of the MCA who received IVT. The frequency and predictors of SSI in the territory of the MCA were different between proximal and distal SSI.