You really don't understand the neuronal cascade of death at all, do you? Since you haven't stopped this cascade of death, the first week hundreds of millions to billions of neurons die because of incompetence in not solving this! And you don't understand why you are completely wrong on early mobilization, get out of stroke and find something easier!
Does Vessel Occlusion Drive the Harmful Effect of Very Early Mobilization in Patients With Ischemic Stroke? A Post Hoc Analysis of AVERT
Abstract
BACKGROUND:
The
international trial AVERT (A Very Early Rehabilitation Trial) found
that very early mobilization (VEM; commenced <24 hours after stroke)
negatively affected functional outcome (modified Rankin Scale [mRS]).
The drivers of this effect remain unclear. One plausible mechanism is
that high-dose upright activity worsens cerebral perfusion in patients
with cerebral large vessel occlusion (LVO). For this retrospective AVERT
substudy, we collected brain imaging from participants from 8 AVERT
sites (n=910) to explore the potential relationship between LVO, VEM,
and mRS in ischemic stroke. We hypothesized that patients with evidence
of LVO would be adversely affected by VEM compared with non-LVO
patients.
METHODS:
In
this post hoc analysis of a randomized controlled trial, 2 neurologists
independently classified patients with ischemic stroke as having LVO
via direct (vessel truncation on computed tomography/magnetic resonance
imaging angiography) or indirect evidence (hyperdense artery sign or
established infarction of >2/3 of an arterial territory) from brain
imaging obtained ≤7 days poststroke. The association between LVO, VEM,
and 3- and 12-month mRS was tested using logistic regression, adjusted
for age, treatment with thrombolysis, and baseline National Institutes
of Health Stroke Scale.
RESULTS:
Interrater
reliability for LVO signs was high (weighted κ, 0.842 [95% CI,
0.631–0.969]). Of 689 participants (37.2% female; median age, 74.5
[interquartile range, 65.0–81.2] years) included in the primary
analysis, 192 (28%) showed direct or indirect evidence of LVO. Computed
tomography/magnetic resonance imaging angiography were available in 179
(26%) of those 689 participants. While LVO was associated with poor mRS
(>2) at 3 months (adjusted odds ratio, 2.15 [95% CI, 1.29–3.64]) and
12 months (adjusted odds ratio, 1.76 [95% CI, 1.1–2.84]; P=0.02), there was no significant interaction between VEM, LVO, and mRS (P=0.16).
CONCLUSIONS:
We
found no evidence that VEM was specifically harmful in patients with
LVO. However, as arterial imaging was not consistently obtained before
first mobilization, larger prospective studies with standardized
measures of LVO are needed to fully address this question.
REGISTRATION:
URL: xxx; Unique identifier: ACTRN12606000185561.
Graphical Abstract
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