Predictors of Unexplained Early Neurological Deterioration After Endovascular Treatment for Acute Ischemic Stroke

Survivors don't need predictions of damage you blithering idiots. They need solutions that prevent such damage. GET THERE! 

Oops, I'm not playing by the polite rules of Dale Carnegie,  'How to Win Friends and Influence People'. 

Politeness will never solve anything in stroke. Yes, I'm a bomb thrower and proud of it. Someday a stroke 'leader' will ream me out for making them look bad by being truthful , I look forward to that day.

Predictors of Unexplained Early Neurological Deterioration After Endovascular Treatment for Acute Ischemic Stroke

 

Jean-Baptiste Girot

,

Sébastien Richard

,

Florent Gariel

,

Igor Sibon

,

Julien Labreuche

,

Maéva Kyheng

,

Benjamin Gory

,

Cyril Dargazanli

,

Benjamin Maier

,

Arturo Consoli

, … See all authors

and The Endovascular Treatment in Ischemic Stroke research investigators are as follows

Originally published14 Sep 2020https://doi.org/10.1161/STROKEAHA.120.029494Stroke. ;0

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 modifiedRankinScale 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.

Footnotes

This manuscript was sent to Georgios Tsivgoulis, Consulting Editor, for review by expert referees, editorial decision, and final disposition.

*A list of all ETIS Investigators is given in the Appendix.

For Sources of Funding and Disclosures, see page XXX.

Correspondence to: Romain Bourcier, MD, PhD, Neuroradiology Department, Nantes University Hospital, Nantes, France. Email romain.bourcier@chu-nantes.fr