Yan Shi, Yongtao Liu, Jingjing Sun, Bing Zhao, Qingfan Xie

Department of Rehabilitation Medicine, Xingtai People’s Hospital, Xingtai City, Hebei Province, People’s Republic of China

Correspondence: Qingfan Xie, Department of Rehabilitation Medicine, Xingtai People’s Hospital, No. 818 Xiangdu North Road, Xiangdu District, Xingtai City, Hebei Province, 054000, People’s Republic of China, Tel +86-03193956196, Email X221021qf@126.com

Objective: To investigate the risk factors and predictive value for poor prognosis following small artery occlusion stroke (SAO) or lacunar stroke.
Methods: A retrospective cohort of 100 SAO patients who received their first intravenous thrombolysis (IVT) treatment with alteplase between March 2019 and March 2021 was collected. Based on the modified Rankin Scale (mRS) score of < 3 at 90 days post-admission, patients were divided into a good prognosis group (61 cases) and a poor prognosis group (39 cases) for comparative analysis.
Results: In our retrospective cohort study of 100 SAO patients treated with IVT from March 2019 to March 2021, we found no significant differences in gender, age or BMI between the 61 patients with good prognosis and the 39 with poor prognosis, although smoking habits varied. Statistically differences were observed between the two groups in terms of time from onset to hospital admission for thrombolysis (48.59± 20.14 vs 40.03± 23.73 min, t=2.202, P=0.030), triglycerides (1.56± 0.92 vs 1.20± 0.68 mmol/L, t=2.069, P=0.041), and smoking prevalence (42.62% vs 20.51%, χ2=5.183, P=0.023). Regression analysis indicated that shorter time from onset to hospital admission for thrombolysis (OR=0.978, 95% CI: 0.957– 0.993) was a protective factor against poor prognosis post-thrombolysis in SAO patients, while a history of smoking (OR=2.881, 95% CI: 1.115– 7.444) was a risk factor for poor prognosis post-thrombolysis. The area under the curve (AUC) for predicting poor prognosis post-thrombolysis in SAO patients based on time from onset to hospital admission was 0.662 (95% CI: 0.552– 0.771), with a cutoff value of 36.5 min; the AUC for predicting poor prognosis based on smoking history was 0.614 (95% CI: 0.502– 0.726).
Conclusion: An extended duration from onset to hospital admission for thrombolysis and smoking are identified as significant risk factors for poor prognosis following thrombolysis in SAO patients, both of which have substantial predictive value.

Keywords: small artery occlusion stroke, lacunar stroke, risk factors, poor prognosis