C-reactive Protein is A Predictor of Deterioration of Acute Internal Carotid Artery M1 Qcclusion Following Recanalization.

ABSTRACT

INTRODUCTION: Administration of intravenous recombinant tissue plasminogen activator (rt-PA) and mechanical thrombectomy (MT) have become standard therapeutic approaches for acute internal carotid artery and middle cerebral artery M1 segment occlusion (ICA/M1O). However, clinical deterioration of the condition is still observed in some cases. OBJECTIVE: We aimed to identify patients' factors associated with exacerbation. This was a single-center, retrospective study of 35 consecutive patients with acute ICA/M1O who underwent rt-PA/rt-PA and MT at our hospital between January 2016 and September 2019. We divided patients into two groups based on the total NIHSS score at discharge the "improvement" and "exacerbation" groups. Clinical characteristics, laboratory data, and imaging findings were compared between the groups. RESULTS: The improvement group (13 patients [37%]) had a lower mean age (70 vs. 81 years, p = 0.02), National Institutes of Health Stroke Scale score (NIHSS, 13 vs. 19, p = 0.02), and C-reactive protein (CRP) levels (0.24 vs. 0.92 mg/dl, p < 0.01) than the exacerbation group (22 patients [63%]). Receiver operating characteristic curve analysis revealed the cut-off age to be 79 (sensitivity 76.9%, specificity 72.7%), NIHSS score to be 20 (sensitivity 92.3%, specificity 63.6%), and CRP to be 0.14 mg/dl (sensitivity 69.2%, specificity 81.8%). Multivariate analysis confirmed a CRP level of >0.14 mg/dl (odds ratio, 10.16; 95% confidence interval 1.38-75.13; p = 0.01) to be independently associated with clinical deterioration at discharge. CONCLUSIONS: A CRP level of >0.14 mg/dl is a strong predictor of clinical deterioration at discharge in patients with acute ICA/M1O undergoing recanalization therapy.