IMR Press / JIN / Volume 22 / Issue 2 / DOI: 10.31083/j.jin2202052
Open Access Systematic Review
Predictors of Early Neurological Deterioration Occurring within 24 h in Acute Ischemic Stroke following Reperfusion Therapy: A Systematic Review and Meta-Analysis
Han-Xu Shi1,2,†Chen Li3,†Yi-Qun Zhang4,†Xia Li3,5Ao-Fei Liu3Yun-E Liu3Wei-Jian Jiang3,*Jin Lv1,3,*
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1 Central Laboratory of Research Department, the PLA Rocket Force Characteristic Medical Center, 100088 Beijing, China
2 School of Public Health, University of Hong Kong, 999077 Hong Kong, China
3 Department of Vascular Neurosurgery, New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, 100088 Beijing, China
4 Department of Critical Care Medicine, New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, 100088 Beijing, China
5 Department of Neurology, Baotou Central Hospital, 014040 Baotou, Inner Mongolia, China
*Correspondence: (Wei-Jian Jiang); (Jin Lv)
These authors contributed equally.
J. Integr. Neurosci. 2023, 22(2), 52;
Submitted: 13 November 2022 | Revised: 12 December 2022 | Accepted: 15 December 2022 | Published: 23 March 2023
Copyright: © 2023 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Background: Early neurological deterioration (END), generally defined as the increment of National Institutes of Health Stroke Scale (NIHSS) score 4 within 24 hours, lead to poor clinical outcome in acute ischemic stroke (AIS) patients receiving reperfusion therapies including intravenous thrombolysis (IVT) and/or endovascular treatment (EVT). This systematic review and meta-analysis aimed to explore multiple predictors of END following reperfusion therapies. Methods: We searched PubMed, Web of Science and EBSCO for all studies on END in AIS patients receiving IVT and/or EVT published between January 2000 and December 2022. A random-effects meta-analysis was conducted and presented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The quality of each included studies was assessed by calculating a total score according to the STROBE or CONSORT criteria. Publication bias and heterogeneity were also evaluated using the Eggers/Peters test, funnel plots and sensitivity analysis. Results: A total of 29 studies involving 65,960 AIS patients were included. The quality of evidence is moderate to high, and all studies have no publication bias. The overall incidence of END occurring after reperfusion therapy in AIS patients was 14% ((95% confidence intervals (CI), 12%–15%)). Age, systolic blood pressure (SBP), glucose levels at admission, the onset to treatment time (OTT), hypertension, diabetes mellitus, arterial fibrillation, and internal cerebral artery occlusion were significantly associated with END following reperfusion therapy. Conclusions: Numerous factors are associated with END occurrence in AIS patients receiving reperfusion therapy. Management of the risk factors of END may improve the functional outcome after reperfusion treatment.

early neurological deterioration (END)
intravenous thrombolysis (IVT)
endovascular treatment (EVT)
reperfusion therapy
2013CB733805/National Key Basic Research Program of China
81871464/National Natural Science Foundation of China
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