Magnetic resonance imaging-based evaluation of alteplase combined with edaravone dexborneol therapy in acute anterior circulation large vessel occlusion cerebral infarction

This study aimed to investigate the dynamic evolution of neurological functional recovery and immunomodulation in patients with acute anterior circulation large vessel occlusion (AC-LVO) assessed by magnetic resonance imaging (MRI) following alteplase combined with edaravone dexborneol. A retrospective analysis was conducted on 172 AC-LVO patients, randomly divided into control group (alteplase alone, n = 86) and combination group (intravenous alteplase thrombolysis + edaravone dexborneol, n = 86). MRI assessed dynamic changes in the infarct area before and after treatment. Neurological function was evaluated using the National Institutes of Health Stroke Scale (NIHSS). Serum levels of glial fibrillary acidic protein (GFAP) and S100β were measured by ELISA. T-cell subsets were analyzed via flow cytometry, immunoglobulin levels were determined by immunoturbidimetry, and erythrocyte complement C3b receptor rosette rate (RBC-C3bRR) and erythrocyte immune complex rosette rate (RBC-ICR) were assessed using receptor adhesion assays. Alteplase combined with edaravone dexborneol facilitated vascular recanalization, evidenced by a reduction in the hyperintense area on DWI, an increased proportion of apparent diffusion coefficient (ADC) pseudonormalization, and a recovery of ADC values to near-threshold levels. The infarct region exhibited uniform hyperintensity on T2WI sequences. Combined group demonstrated substantially lower NIHSS scores at 24 h, 14 d, and 30 d post-treatment versus control group ( P < 0.05), and higher overall treatment efficacy versus the control group (94.19 % vs. 79.07 %, P = 0.004). Greater reductions in GFAP and S100β levels were observed in combined group ( P < 0.05). Immunological assessments revealed superior regulation of T-cell subsets, humoral immunity, and erythrocyte immune function in combined group ( P < 0.05). The total incidence of adverse reactions was 8.14 % (7 cases) in combined group versus 5.81 % (5 cases) in control group, without statistical significance ( χ 2 = 0.347, P = 0.555). MRI-based evaluation of combined alteplase and edaravone dexborneol therapy enhances neurological recovery and immune modulation in patients with acute AC-LVO, outperforming alteplase monotherapy without increasing adverse risks, providing a novel integrated intervention strategy for post-recanalization neuroprotection.