Our objective was to evaluate the association of neutrophilia with rapid stroke progression. 

Rapid stroke progressors with large vessel occlusion (LVO) have a worse prognosis than their time-matched cohorts receiving IV thrombolytics and/or mechanical thrombectomy. To our knowledge, there are no studies that investigated neutrophilia with rapid stroke progression in the setting of LVO. 

Initial white blood cell (WBC) and absolute neutrophil counts (ANC) were collected for subjects presenting with acute ischemic stroke secondary to LVO who received IV thrombolytics and/or mechanical thrombectomy within 4.5 and 6 hours, respectively. Rapid stroke progression was determined by Alberta Stroke Program Early CT Score (ASPECTS) on initial CT head. Baseline and discharge NIHSS, age, and follow up mRS were also compared to presenting WBC and ANC. Spearman’s rho was used for correlation. Social Science Statistics was used for data analysis.

From October 2020 to April 2021, the association between neutrophilia and stroke progression was evaluated in 19 subjects receiving Tenecteplase (n=16; 6 females; age, 63.25 95% CI [54.9207, 71.5793]) and Alteplase (n=4; 2 females; mean age 59, 95% CI [38.13, 79.87]) for LVO causing disabling neurological deficits. Mechanical thrombectomy was attempted in all subjects. The association between higher ANC and lower ASPECTS score reached statistical significance (rs=-0.49255, p=0.04457). There was no significant association of white blood cell (WBC) and ASPECTS score. WBC and ANC were not associated with baseline or discharge NIHSS, age, or follow up mRS.

Rapid stroke progression as measured by presenting ASPECTS score may be associated with neutrophilia. Larger prospective clinical trials are needed to validate our results