A Guenego1,2, R Bourcier3, M Guillen4, D Weisenburger-Lile5, B Lapergue5, B Gory6,7, S Richard8,9, C Ducroux1, M Piotin1, R Blanc1, J Labreuche10, L Lucas11, L Detraz3, M Aubertin1, C Dargazanli12, A Benali12, S Vannier4, F Eugene13, R Lun14, G Walker14,15, A Consoli16, R Fahed1,14. 1. Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France. 2. Department of Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium. 3. Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, L'institut du thorax, Inserm 1087, CNRS, UNIV Nantes, Nantes, France. 4. Neurovascular Unit, Centre Hospitalier Universitaire Pontchaillou, Rennes, France. 5. Neurovascular Unit, Foch Hospital, Suresnes, France. 6. Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, CHRU-Nancy, Nancy, France. 7. IADI, INSERM U1254, Université de Lorraine, Nancy, France. 8. Stroke Unit, Department of Neurology, Université de Lorraine, CHRU-Nancy, Nancy, France. 9. INSERM U1116, CHRU-Nancy, Nancy, France. 10. ULR 2694-METRICS: Evaluation Des Technologies De Santé et des Pratiques Médicales, Univ. Lille, CHU Lille, Lille, France. 11. Neurovascular Unit, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France. 12. Department of Neuroradiology, Centre Hospitalier Universitaire Gui de Chauliac, Montpellier, France. 13. Department of Neuroradiology, Centre Hospitalier Universitaire Pontchaillou, Rennes, France. 14. Department of Medicine, Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON, Canada. 15. Department of Medicine, Division of Neurology, Royal Columbian Hospital, New Westminster, BC, Canada. 16. Department of Neuroradiology, Foch Hospital, Suresnes, France.
Abstract
BACKGROUND AND PURPOSE: Mechanical thrombectomy (MT) is the standard of care for patients with anterior circulation large vessel occlusion. Early neurological improvement (ENI), defined as a reduction of ≥ 8 on the National Institutes of Health Stroke Scale (NIHSS) compared with baseline score, or an NIHSS score of 0 or 1 at 24 h after MT, is a strong predictor of 3-month favorable outcome in such patients. The impact of ENI after MT in stroke patients with basilar artery occlusion (BAO) on 3-month outcome is not clear. We aimed to study the effects of ENI in patients with BAO. METHODS: We performed a retrospective analysis of a multicenter prospective cohort of all consecutive stroke patients with BAO who underwent MT. We compared clinical outcomes between BAO patient groups according to ENI status. Multivariate analyses were performed to determine the impact of ENI on favorable 90-day outcome (modified Rankin scale score 0-3) and to report factors contributing to ENI. RESULTS: A total of 237 patients were included. ENI was observed in 70 patients (30%). Outcomes were significantly better in ENI-positive patients, with 84% achieving favorable outcome (mRS score 0-3) at 3 months versus 30% for ENI-negative patients (P < 0.0001). In multivariate analysis, ENI was an independent predictive factor associated with higher rates of favorable outcome {odds ratio (OR) 18.12 [95% confidence interval (CI) 3.95-83.10]; P = 0.0001}. Higher number of passes [OR 0.62 (95% CI 0.43-0.89); P = 0.010] and need for stenting [OR 0.27 (95% CI 0.07-0.95); P = 0.041] were negatively associated with ENI. CONCLUSION: Early neurological improvement on day 1 following MT for BAO is a strong independent predictor of a favorable 3-month clinical outcome.
BACKGROUND AND PURPOSE: Mechanical thrombectomy (MT) is the standard of care for patients with anterior circulation large vessel occlusion. Early neurological improvement (ENI), defined as a reduction of ≥ 8 on the National Institutes of Health Stroke Scale (NIHSS) compared with baseline score, or an NIHSS score of 0 or 1 at 24 h after MT, is a strong predictor of 3-month favorable outcome in such patients. The impact of ENI after MT in strokepatients with basilar artery occlusion (BAO) on 3-month outcome is not clear. We aimed to study the effects of ENI in patients with BAO. METHODS: We performed a retrospective analysis of a multicenter prospective cohort of all consecutive strokepatients with BAO who underwent MT. We compared clinical outcomes between BAO patient groups according to ENI status. Multivariate analyses were performed to determine the impact of ENI on favorable 90-day outcome (modified Rankin scale score 0-3) and to report factors contributing to ENI. RESULTS: A total of 237 patients were included. ENI was observed in 70 patients (30%). Outcomes were significantly better in ENI-positive patients, with 84% achieving favorable outcome (mRS score 0-3) at 3 months versus 30% for ENI-negative patients (P < 0.0001). In multivariate analysis, ENI was an independent predictive factor associated with higher rates of favorable outcome {odds ratio (OR) 18.12 [95% confidence interval (CI) 3.95-83.10]; P = 0.0001}. Higher number of passes [OR 0.62 (95% CI 0.43-0.89); P = 0.010] and need for stenting [OR 0.27 (95% CI 0.07-0.95); P = 0.041] were negatively associated with ENI. CONCLUSION: Early neurological improvement on day 1 following MT for BAO is a strong independent predictor of a favorable 3-month clinical outcome.