Early Quantitative Electroencephalography Parameters Predicting Clinical Outcomes of Intravenous rt-PA Thrombolysis in Acute Ischemic Stroke: A Retrospective Cohort Study.

AIMS/

BACKGROUND

Timely and accurate assessment of the response to intravenous thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) is crucial for guiding subsequent interventions in acute ischemic stroke (AIS). Quantitative electroencephalography (qEEG) offers a real-time measure of cerebral function sensitive to ischemia. This study aimed to investigate the predictive value of ultra-early dynamic changes in qEEG parameters following thrombolysis and develop a predictive model for 24-hour clinical efficacy.

METHODS

We conducted a single-center retrospective analysis of 216 patients with AIS who received intravenous rt-PA at the Stroke Center of Xinchang Hospital Affiliated to Shaoxing University between January 2023 and December 2024. qEEG recordings were acquired immediately before (T0) and 1 hour after the initiation of rt-PA infusion (T1). The primary qEEG parameter was the Delta-Theta/Alpha-Beta Ratio (DTABR). We calculated the DTABR reduction value (T0 DTABR-T1 DTABR) to quantify early neurophysiological improvement. The primary outcome was early clinical efficacy at 24 hours, defined as a reduction of ≥4 points in the National Institutes of Health Stroke Scale (NIHSS) score or an NIHSS score of 0-1. The cohort was randomized (7:3) into training (n = 151) and validation (n = 65) sets. A nomogram was constructed based on multivariate logistic regression. Model performance was evaluated using the area under the curve (AUC), calibration plots with the Hosmer-Lemeshow test, and decision curve analysis (DCA). SHapley Additive exPlanations (SHAP) analysis was employed for model interpretation.

RESULTS

Early clinical efficacy was achieved in 53.7% of patients. The DTABR reduction value was significantly higher in responders compared to non-responders (median 1.20 vs. 0.20, p < 0.001). In the multivariate analysis, the DTABR reduction value emerged as a strong independent predictor of favorable outcomes (adjusted odds ratio [OR] = 2.745, 95% confidence interval [CI]: 1.283-5.870, p = 0.009). A nomogram integrating this dynamic qEEG marker with clinical variables (age, diabetes, onset-to-needle time, baseline diastolic blood pressure, baseline glucose, baseline NIHSS) demonstrated good discriminative ability, with an AUC of 0.77 (95% CI: 0.70-0.85) in the training set and 0.77 (95% CI: 0.65-0.88) in the validation set. The model exhibited excellent calibration and provided significant net clinical benefit across a wide range of threshold probabilities in the DCA. SHAP analysis identified the DTABR reduction value as the most influential feature.

CONCLUSION

The magnitude of DTABR reduction within 1 hour of initiating intravenous thrombolysis is a robust, independent biomarker for early neurophysiological recovery. The developed nomogram offers a validated tool for real-time, individualized prediction of early treatment efficacy, potentially facilitating timely optimization of management strategies for AIS.