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.

中文翻译：

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C反应蛋白是再通气后急性内颈动脉M1闭塞恶化的预测指标。

引言静脉内重组组织纤溶酶原激活剂（rt-PA）和机械血栓切除术（MT）的使用已成为急性颈内动脉和大脑中动脉M1段闭塞（ICA / M1O）的标准治疗方法。但是，在某些情况下仍观察到该病的临床恶化。目的我们旨在确定患者病情加重的因素。这是一项单中心回顾性研究，研究对象是2016年1月至2019年9月在我院接受rt-PA / rt-PA和MT的35例急性ICA / M1O连续患者。根据总的NIHSS，我们将患者分为两组出院分数：“改善”和“恶化”组。比较两组之间的临床特征，实验室数据和影像学发现。结果改善组（13例[37％]）平均年龄较低（70岁比81岁，p = 0.02），美国国立卫生研究院卒中量表评分（NIHSS，13岁对19，p = 0.02）和C-反应蛋白（CRP）水平（0.24 vs. 0.92 mg / dl，p <0.01）比急性加重组（22例，占63％）。接受者操作特征曲线分析显示，临界年龄为79岁（敏感性76.9％，特异性72.7％），NIHSS评分为20（敏感性92.3％，特异性63.6％），CRP为0.14 mg / dl（敏感性69.2） ％，特异性81.8％）。多变量分析证实CRP水平> 0.14 mg / dl（比值比为10.16； 95％置信区间1.38-75.13； p = 0.01）与出院时的临床恶化独立相关。结论CRP水平> 0。