Deans' stroke musings: Early neurological deterioration in patients with acute ischemic stroke is linked to unfavorable cerebral venous outflow

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, January 29, 2024

Early neurological deterioration in patients with acute ischemic stroke is linked to unfavorable cerebral venous outflow

You described a problem; did nothing to solve it! USELESS! I'd fire all of you!

Early neurological deterioration in patients with acute ischemic stroke is linked to unfavorable cerebral venous outflow

Christian Heitkamp https://orcid.org/0000-0002-8988-0918 c.heitkamp@uke.de, Laurens Winkelmeier https://orcid.org/0000-0002-9103-5983, and Tobias D Faizy https://orcid.org/0000-0002-1631-2020View all authors and affiliations

OnlineFirst

https://doi.org/10.1177/23969873231208277

Abstract

Introduction:

Early neurological deterioration (END) is associated with poor outcomes in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO). Causes of END after mechanical thrombectomy (MT) include unsuccessful recanalization and reperfusion hemorrhages. However, little is known about END excluding the aforementioned causes. We aimed to investigate factors associated with unexplained END (END_unexplained) with regard to the cerebral collateral status.

Patients and Methods:

Multicenter retrospective study of AIS-LVO patients with successful MT (mTICI 2b-3). On admission CT angiography (CTA), pial arterial collaterals and venous outflow (VO) were assessed using the modified Tan-Scale and the Cortical Vein Opacification Score (COVES), respectively. END_unexplained was defined as an increase in NIHSS score of ⩾ 4 within the first 24 hours after MT without parenchymal hemorrhage on follow-up imaging. Multivariable regression analyses were performed to examine factors of END_unexplained and unfavorable functional outcome (modified Rankin Scale score 3-6).

Results:

A total of 620 patients met the inclusion criteria. END_unexplained occurred in 10% of patients. While there was no significant difference in pial arterial collaterals, patients with END_unexplained exhibited more often unfavorable VO (81% vs. 53%; P < 0.001). Unfavorable VO (aOR [95% CI]; 2.56 [1.02-6.40]; P = 0.045) was an independent predictor of END_unexplained. END_unexplained was independently associated with unfavorable functional outcomes at 90 days (aOR [95% CI]; 6.25 [2.06-18.94]; P = 0.001).

Discussion and Conclusion:

Unfavorable VO on admission CTA was associated with END_unexplained. END_unexplained was independently linked to unfavorable functional outcomes at 90 days. Identifying AIS-LVO patients at risk of END_unexplained may help to select patients for intensified monitoring and guide to optimal treatment regimes.