关键词: 脑梗死, 大脑中动脉, 药物溶栓, 血管再通, 预后

Abstract:

Objective To identify clinical factors associated with 3-month functional outcome after intravenous thrombolysis in patients with acute middle cerebral artery (MCA) infarction. Methods We retrospectively reviewed 138 patients with acute MCA infarction treated with intravenous thrombolysis at Nanyang Central Hospital between April 2023 and January 2025. Functional outcome at 3 months was dichotomized as favorable (modified Rankin Scale ≤2) or unfavorable (>2). Baseline demographic, clinical, and laboratory variables, including age, admission National Institutes of Health Stroke Scale (NIHSS) score, onset-to-treatment time (treatment time window), fasting blood glucose, fibrinogen, and collateral circulation grade, were compared between groups. Univariate comparisons were followed by multivariate logistic regression to identify independent predictors of poor outcome. Results Of 138 patients, 87 had a favorable outcome and 51 an unfavorable outcome at 3 months. Compared with the favorable-outcome group, the unfavorable-outcome group was older and had a longer treatment time window, higher admission NIHSS scores, higher fasting blood glucose, and higher fibrinogen; collateral circulation grades were significantly worse in the unfavorable group (all P<0.05). Multivariate logistic regression identified older age, higher admission NIHSS score, longer treatment time window, elevated fasting blood glucose, and poorer collateral circulation grade as independent predictors of unfavorable 3-month outcome (P<0.05). Conclusion In patients with acute MCA infarction treated with intravenous thrombolysis, poor 3-month outcome is independently associated with advanced age, high admission NIHSS score, long treatment time window, high fasting blood glucose, and poor collateral circulation grade. Targeted clinical interventions are required to improve outcomes.

Key words: brain infarction, middle cerebral artery, pharmacological thrombolysis, blood vessel reperfusion, prognosis