Early neurological deterioration as a predictor of outcomes after endovascular thrombectomy for stroke: A systematic review and meta-analysis

Abstract

Background Early neurological deterioration (END) is a potential predictor for 90-day outcomes following mechanical thrombectomy for acute ischemic stroke (AIS). We performed a systematic review and meta-analysis to better understand whether END can be used as a surrogate for long-term outcomes. Methods Following the PRISMA guidelines, a systematic literature review of the English language literature was conducted using PubMed, MEDLINE, and Embase. END definition was cataloged for each included study. Outcomes of interest included 90-day modified Rankin Scale (mRS) 0–2, symptomatic intracranial hemorrhage (sICH), mortality, and thrombolysis in cerebral infarction (TICI) 2b-3. We calculated pooled odds ratios (ORs) and their corresponding 95% confidence intervals (CI) for all definitions of END. Results We included seven studies with 2992 patients in our analysis. There was a significant, inverse association with END and mRS 0–2 rates (OR = 0.15; 95% CI = 0.08–0.29; P-value< 0.001). Moreover, END was a significant predictor of increased odds for reported sICH rates (OR = 16.37; 95% CI = 7.66–34.99; P-value< 0.001). Furthermore, there was a significant association between END and increase in mortality rates (OR = 6.79; 95% CI = 2.62–17.62; P-value< 0.001). There was no significant association between END and rates of TICI 2b-3 (OR = 0.53; 95% CI = 0.27–1.05; p = 0.069). Conclusions Broadly defined, END holds value as a potential predictor of rates of mRS 0–2 at 90 days and is associated with higher rates of mortality and sICH, but had no correlation with TICI 2b-3.

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

“…Numerous studies demonstrated a significant correlation between END and unfavorable functional long-term outcomes. 7 , 8 , 10 , 11 However research on END unexplained with respect to long-term outcomes remains scarce. 9 In line with the aforementioned study, our work reveals a significant association between END unexplained and unfavorable functional outcomes at 90 days.…”

“… 4 – 6 Previous studies observed a strong association between END and unfavorable long-term functional outcomes in AIS-LVO patients. 7 – 10 Evident causes of END include the presence of reperfusion hemorrhage, unsuccessful recanalization, embolization in new vascular territories, early recurrent ischemic stroke and malignant edema. 11 , 12 The pathophysiology, risk factors and treatment strategies of END including these causes have been discussed in the literature.…”