Evaluation of inflammatory parameters in patients with acute distal middle cerebral artery occlusion treated with intravenous thrombolytic treatment

Vollständiger Abstract

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Objective: The aim of this study was to evaluate the association of various inflammatory parameters with early neurologic damage and three-month functional outcomes in patients with acute distal middle cerebral artery (MCA) occlusion who received intravenous thrombolytic treatment (IV tPA). Materials and Methods: This retrospective exploratory study included 75 patients who underwent IV tPA for distal MCA infarction and had complete clinical and laboratory data. Inflammatory indices were calculated from blood parameters at admission, early neurologic status was assessed using the National Institutes of Health Stroke Scale (NIHSS), and three-month functional status was assessed using the Modified Rankin Score (mRS). Results: Systemic Immune-Inflammation Index (SII), Systemic Inflammatory Response Index (SIRI) and Neutrophil-to-Albumin Ratio (NAR) were positively correlated with mRS in univariate analyses. The NAR also showed an association with the NIHSS score at presentation and demonstrated modest discrimination for the mRS 3-6 group on ROC analysis (AUC=0.694). In multivariable logistic regression adjusted for baseline clinical confounders and onset-to-needle time, the inflammatory indices lost their independent predictive significance, while admission NIHSS remained the strongest independent predictor. Conclusions: While indices such as SII, SIRI and NAR show potential preliminary associations with early neurologic damage and unadjusted three-month functional outcomes in patients with distal MCA infarction treated with IV tPA, they do not carry robust independent prognostic value beyond initial clinical severity. Admission NIHSS remains the most critical predictor of clinical course.