Jean-Baptiste Girot1,2, Sébastien Richard3, Florent Gariel4, Igor Sibon5, Julien Labreuche6, Maéva Kyheng6, Benjamin Gory7, Cyril Dargazanli8, Benjamin Maier9, Arturo Consoli10, Benjamin Daumas-Duport1, Bertrand Lapergue10, Romain Bourcier1. 1. Neuroradiology Department, Nantes University Hospital, France (J.-B.G., B.D.-D., R.B.). 2. Radiology Department, Angers University Hospital, France (J.-B.G.). 3. Department of Neurology, Stroke Unit, CIC-P 1433, INSERM U1116 (S.R.), University Hospital of Nancy, France. 4. Department of Neuroradiology (F.G.), Bordeaux University Hospital, France. 5. Department of Neurology, Stroke Unit (I.S.), Bordeaux University Hospital, France. 6. Lille University, CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, France (J.L., M.K.). 7. Department of Diagnostic and Therapeutic Neuroradiology, INSERM U1254 (B.G.), University Hospital of Nancy, France. 8. Neuroradiology Department, University Hospital Güi de Chauliac, Montpellier, France (C.D.). 9. Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (B.M.). 10. Department of Neurology, Stroke Center, Foch Hospital, Suresnes, France (A.C., B.L.).
Abstract
BACKGROUND AND PURPOSE: Although the efficacy of endovascular treatment (EVT) in patients with anterior circulation ischemic stroke (AIS) is well documented, early neurological deterioration after EVT remains a serious issue associated with poor outcome. Besides obvious causes, such as lack of reperfusion, procedural complications, or parenchymal hemorrhage, early neurological deterioration may remain unexplained (UnEND). Our aim was to investigate predictors of UnEND after EVT in patients with AIS. METHODS: Patients who underwent EVT for AIS, with an initial National Institutes of Health Stroke Scale score >5, Alberta Stroke Program Early CT Score ≥6, and included in a multicenter prospective observational registry were analyzed. Predictors of UnEND, defined as ≥4-point increase in the National Institutes of Health Stroke Scale score between baseline and day 1 after EVT, were determined via center-adjusted analyses. RESULTS: Among the 1925 included in the analysis, 128 UnEND (6.6%) were recorded. In multivariate analysis, predictors of UnEND were diabetes mellitus (odds ratio [OR], 2.17 [95% CI, 1.32-3.56]), prestroke modified Rankin Scale score ≥2 (OR, 2.22 [95% CI, 1.09-4.55]), general anesthesia (OR, 2.55 [95% CI, 1.51-4.30]), admission systolic blood pressure (OR, 1.10 [95% CI, 1.01-1.20]), age (OR, 1.38 [95% CI, 1.14-1.67]), number of passes (OR, 1.16 [95% CI, 1.04-1.28]), direct admission or not to a comprehensive stroke center (OR, 0.49 [95% CI, 0.30-0.81]), and initial National Institutes of Health Stroke Scale score (OR, 0.65 [95% CI, 0.52-0.81]). CONCLUSIONS: Severely impaired AIS patients with nonmodifiable factors are more likely to develop UnEND. Some modifiable predictors of UnEND such as the number of EVT passes could be the object of improvement in AIS management.
BACKGROUND AND PURPOSE: Although the efficacy of endovascular treatment (EVT) in patients with anterior circulation ischemic stroke (AIS) is well documented, early neurological deterioration after EVT remains a serious issue associated with poor outcome. Besides obvious causes, such as lack of reperfusion, procedural complications, or parenchymal hemorrhage, early neurological deterioration may remain unexplained (UnEND). Our aim was to investigate predictors of UnEND after EVT in patients with AIS. METHODS:Patients who underwent EVT for AIS, with an initial National Institutes of Health Stroke Scale score >5, Alberta Stroke Program Early CT Score ≥6, and included in a multicenter prospective observational registry were analyzed. Predictors of UnEND, defined as ≥4-point increase in the National Institutes of Health Stroke Scale score between baseline and day 1 after EVT, were determined via center-adjusted analyses. RESULTS: Among the 1925 included in the analysis, 128 UnEND (6.6%) were recorded. In multivariate analysis, predictors of UnEND were diabetes mellitus (odds ratio [OR], 2.17 [95% CI, 1.32-3.56]), prestroke modified Rankin Scale score ≥2 (OR, 2.22 [95% CI, 1.09-4.55]), general anesthesia (OR, 2.55 [95% CI, 1.51-4.30]), admission systolic blood pressure (OR, 1.10 [95% CI, 1.01-1.20]), age (OR, 1.38 [95% CI, 1.14-1.67]), number of passes (OR, 1.16 [95% CI, 1.04-1.28]), direct admission or not to a comprehensive stroke center (OR, 0.49 [95% CI, 0.30-0.81]), and initial National Institutes of Health Stroke Scale score (OR, 0.65 [95% CI, 0.52-0.81]). CONCLUSIONS: Severely impaired AISpatients with nonmodifiable factors are more likely to develop UnEND. Some modifiable predictors of UnEND such as the number of EVT passes could be the object of improvement in AIS management.
Authors: Ricardo C Nogueira; Marcel Aries; Jatinder S Minhas; Nils H Petersen; Li Xiong; Jana M Kainerstorfer; Pedro Castro Journal: J Cereb Blood Flow Metab Date: 2021-09-13 Impact factor: 6.960
Authors: Philipp Taussky; Guilherme Agnoletto; Ramesh Grandhi; Matthew D Alexander; Ka-Ho Wong; Gregory W Albers; Adam de Havenon Journal: J Neurointerv Surg Date: 2020-10-19 Impact factor: 8.572