{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T03:40:18Z","timestamp":1793072418921,"version":"4.5.0"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,6,2]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Neutrophil extracellular traps contribute to thrombolytic resistance and the no\u2010reflow phenomenon after acute ischemic stroke, thereby impairing microvascular reperfusion and leading to unfavorable clinical outcomes. This study investigated the association between prethrombolytic circulating neutrophil extracellular trap biomarkers, CitH3 (citrullinated histone 3) and MPO (myeloperoxidase)\u2010DNA complexes, and early neurological deterioration (END) in patients with acute ischemic stroke treated with intravenous thrombolysis alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">We prospectively enrolled patients with acute ischemic stroke who received standard\u2010dose alteplase within 4.5\u2009hours of symptom onset (January 2019\u2013April 2023). Venous blood was drawn before intravenous thrombolysis to measure serum CitH3 and MPO\u2010DNA. The primary outcome was END, defined as an increase of \u22654 points in NIHSS score at 24\u2009hours versus baseline. Logistic regression with restricted cubic splines assessed associations between neutrophil extracellular trap biomarkers and END.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Among 287 patients (mean age 61.69\u00b112.41\u2009years, 70.4% male), 45 (15.7%) developed END. Serum CitH3 &gt;17.67\u2009ng\/mL (odds ratio [OR], 3.81 [95% CI, 1.75\u20138.29]) and MPO\u2010DNA &gt;79.72\u2009ng\/mL (OR, 5.58 [95% CI, 2.36\u201313.21]) were independently associated with END. The associations remained significant when treated as continuous variables. Restricted cubic splines confirmed a linear dose\u2013response relationship between higher CitH3 levels and END risk (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      for nonlinearity=0.475). Subgroup analyses revealed stronger associations for CitH3 in patients with coronary artery disease or stroke history (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      for interaction=0.018) and D\u2010dimer &lt;0.50\u2009\u03bcg\/mL (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      for interaction=0.013). A significant interaction of smoking was found between MPO\u2010DNA and END (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      for interaction=0.026).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Serum neutrophil extracellular traps may serve as promising biomarkers associated with END after intravenous thrombolysis in patients with acute ischemic stroke.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.045163","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T10:49:03Z","timestamp":1779706143000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Neutrophil Extracellular Traps Are Associated With Early Neurological Deterioration in Patients With Acute Ischemic Stroke Receiving Intravenous Thrombolysis: A\u00a0Prospective Cohort Study"],"prefix":"10.1161","volume":"15","author":[{"given":"Lulu","family":"Pei","sequence":"first","affiliation":[{"name":"The First Affiliated Hospital of Zhengzhou University","place":["Zhengzhou, China"]},{"name":"The NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease","place":["Zhengzhou, China"]},{"name":"Zhengzhou University","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wan","family":"Zhang","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Zhengzhou University","place":["Zhengzhou, China"]},{"name":"The NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease","place":["Zhengzhou, China"]},{"name":"Zhengzhou University","place":["Zhengzhou, 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