Effect of serum lipid levels on cerebral stroke severity and outcomes after intravenous thrombolysis

Abstract Background Hyperlipidemia has been suggested to influence the severity and outcomes of acute ischemic stroke (AIS). However, its role in AIS patients receiving recombinant tissue plasminogen activator (rtPA) remains controversial. Intravenous thrombolysis has become standard practice in eligible patients with acute ischemic stroke. Understanding the relationship between lipid levels and post-thrombolysis outcomes could help in risk stratification and clinical decision-making. We conducted a prospective observational cohort of 50 adults with AIS who received intravenous rtPA within 4.5 h of onset and had baseline Alberta stroke programme early computed tomography score (ASPECTS) greater than 6, indicating limited early ischemic change. Patients were categorized by lipid profile status, and outcomes were compared between hyperlipidemic and normolipidemic groups. We assessed stroke severity using National Institutes of Health Stroke Scale (NIHSS), functional outcomes using Modified Rankin Scale (mRS), and ischemic burden using ASPECTS. Results Hyperlipidemia was present in 62% of patients and correlated with greater stroke severity P < 0.001), poorer 3-month functional outcomes ( P < 0.001), and larger ischemic cores ( P < 0.001). Follow-up CT showed a significantly higher frequency of middle cerebral artery M1 infarctions in hyperlipidemic patients ( P = 0.038). The multivariate regression indicates that triglycerides level was independently associated with admission NIHSS ( P < 0.001), followed by HDL-C ( P < 0.001). Conclusion Hyperlipidemia is correlated with more severe neurological deficits, poorer functional outcomes, and more extensive ischemic changes on neuroimaging in patients with acute ischemic stroke treated with rtPA. Acute lipid profiling may serve as a practical tool for risk stratification in thrombolyzed stroke patients.