Early Neurological Deterioration Despite Recanalization in Basilar Artery Occlusion Treated by Endovascular Therapy

Zhong, Xi; Tong, Xu; Sun, Xuan; Gao, Feng; Mo, Dapeng; Wang, Yilong; Miao, Zhongrong

doi:10.3389/fneur.2020.592003

Cited by 7 publications

(6 citation statements)

References 35 publications

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“…In our study, the number of menchanical thrombectomy (MT) passes was not an independent predictor of END unexplained , which was different from the conclusion of Girot et al 7. Zhong et al reported that time from onset to recanalization was one of the independent predictors of END in acute basilar occlusion after EVT 30. The different conclusions of these three studies might be explained by the different study populations.…”

Section: Discussioncontrasting

confidence: 99%

Unexplained early neurological deterioration after endovascular treatment for acute large vessel occlusion: incidence, predictors, and clinical impact: Data from ANGEL-ACT registry

Sun

Tong

Huo

et al. 2021

J NeuroIntervent Surg

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BackgroundEarly neurological deterioration (END) may occur in some patients with acute large vessel occlusion (LVO) undergoing endovascular treatment (EVT). Despite several clear causes of END, such as symptomatic intracranial hemorrhage, failure of recanalization, and intraprocedure complications, a particular END, termed unexplained END (ENDunexplained), exists. We aimed to investigate the incidence, independent predictors, and clinical impact of ENDunexplained after EVT in patients with acute LVO.MethodsSubjects were selected from the ANGEL-ACT registry. ENDunexplained was defined as ≥4-point increase in the National Institutes of Health Stroke Scale (NIHSS) score between baseline and 24 hours after EVT, without the causes listed above. Logistic regression analyses were performed to determine the independent predictors of ENDunexplained, as well as the association between ENDunexplained and 90-day outcomes assessed by modified Rankin Scale (mRS) score.ResultsAmong the 1557 enrolled patients, the incidence of ENDunexplained was 4.3% (67/1557). Admission NIHSS ≤8 (OR=6.88, 95% CI 3.86 to 12.26, p<0.001), general anesthesia (OR=3.15, 95% CI 1.81 to 5.48, p<0.001), admission neutrophil to lymphocyte ratio >5 (OR=2.82, 95% CI 1.61 to 4.94, p<0.001), and number of EVT attempts >3 (OR=2.11, 95% CI 1.14 to 3.89, p=0.018) were associated independently with a high risk of ENDunexplained. Furthermore, patients with ENDunexplained were associated with a shift toward worse 90-day outcomes (mRS 5 vs 3, common OR=5.24, 95% CI 3.22 to 8.52, p<0.001).ConclusionsENDunexplained associated with poor 90day outcomes occurred in 4.3% of patients with acute LVO undergoing EVT. Several independent predictors of ENDunexplained were identified in this study, which should be considered in daily practice to improve acute LVO management.Clinical trial Registrationhttp://wwwclinicaltrialsgovNCT03370939.

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Section: Discussioncontrasting

confidence: 99%

Unexplained early neurological deterioration after endovascular treatment for acute large vessel occlusion: incidence, predictors, and clinical impact: Data from ANGEL-ACT registry

Sun

Tong

Huo

et al. 2021

J NeuroIntervent Surg

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“…All the patients were treated with EVT, 131 patients (62.1%) received additional intravenous thrombolysis. The median NIHSS score on admission was 14 in both groups, whereas the median 24-h NIHSS score differed significantly, with 32 (IQR:22-33) in the END group versus 6 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) in the group without END. Figure 1 illustrates the course of the NIHSS score between the baseline and 24 h of all the patients.…”

Section: Patient Characteristicsmentioning

confidence: 87%

“…Together with multiparametric CT or MRI imaging, it guides therapy decision making toward intravenous thrombolysis (IVT) and endovascular treatment (EVT) [ 4 ]. Early neurological deterioration (END) is commonly defined as increase in ≥4 points of the NIHSS between pretreatment (NIHSS on admission) and day one (24-h NIHSS) [ 5 , 6 , 7 ]. END occurs in 10–40% of patients, depending on different definitional sub-criteria and/or inclusion criteria [ 5 , 6 , 7 , 8 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…Early neurological deterioration (END) is commonly defined as increase in ≥4 points of the NIHSS between pretreatment (NIHSS on admission) and day one (24-h NIHSS) [ 5 , 6 , 7 ]. END occurs in 10–40% of patients, depending on different definitional sub-criteria and/or inclusion criteria [ 5 , 6 , 7 , 8 , 9 , 10 ]. However, studies have independently shown that the affected patients have a significantly worse functional outcome.…”

Section: Introductionmentioning

confidence: 99%

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Course of Early Neurologic Symptom Severity after Endovascular Treatment of Anterior Circulation Large Vessel Occlusion Stroke: Association with Baseline Multiparametric CT Imaging and Clinical Parameters

et al. 2021

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Background: Neurologic symptom severity and deterioration at 24 hours (h) predict long-term outcomes in patients with acute large vessel occlusion (LVO) stroke of the anterior circulation. We aimed to examine the association of baseline multiparametric CT imaging and clinical factors with the course of neurologic symptom severity in the first 24 h after endovascular treatment (EVT). Methods: Patients with LVO stroke of the anterior circulation were selected from a prospectively acquired consecutive cohort of patients who underwent multiparametric CT, including non-contrast CT, CT angiography and CT perfusion before EVT. The symptom severity was assessed on admission and after 24 h using the 42-point National Institutes of Health Stroke Scale (NIHSS). Clinical and imaging data were compared between patients with and without early neurological deterioration (END). END was defined as an increase in ≥4 points, and a significant clinical improvement as a decrease in ≥4 points, compared to NIHSS on admission. Multivariate regression analyses were used to determine independent associations of imaging and clinical parameters with NIHSS score increase or decrease in the first 24 h. Results: A total of 211 patients were included, of whom 38 (18.0%) had an END. END was significantly associated with occlusion of the internal carotid artery (odds ratio (OR), 4.25; 95% CI, 1.90–9.47) and the carotid T (OR, 6.34; 95% CI, 2.56–15.71), clot burden score (OR, 0.79; 95% CI, 0.68–0.92) and total ischemic volume (OR, 1.01; 95% CI, 1.00–1.01). In a comprehensive multivariate analysis model including periprocedural parameters and complications after EVT, carotid T occlusion remained independently associated with END, next to reperfusion status and intracranial hemorrhage. Favorable reperfusion status and small ischemic core volume were associated with clinical improvement after 24 h. Conclusions: The use of imaging parameters as a surrogate for early NIHSS progression in an acute LVO stroke after EVT reached limited performance with only carotid T occlusion as an independent predictor of END. Reperfusion status and early complications in terms of intracranial hemorrhage are critical factors that influence patient outcome in the acute stroke phase after EVT.

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“…17 It has been previously reported that a lower NIHSS might be a risk for early neurological deterioration. 26 However, results of the subgroup analysis have to be interpreted with caution as they rely only on restricted numbers of observations in the according subgroups.…”

Section: Discussionmentioning

confidence: 99%

Thrombectomy in basilar artery occlusion

Sommer

Scharer

Posekany

et al. 2022

International Journal of Stroke

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Background and Purpose: The benefit of thrombectomy (TE) for acute ischemic stroke (AIS) in patients suffering basilar artery occlusion (BAO) is still unclear. Our aim was to analyze functional outcome after 3 months in BAO compared to anterior circulation large vessel occlusion (ACLVO) in a nationwide registry. Methods: Patients enrolled into the Austrian Endostroke Registry from 2013 to 2018 were analyzed. We used propensity score matching to control for imbalances and to compare patients with BAO and ACLVO. The primary outcome was favorable functional outcome after 3 months measured by the modified Rankin Scale (mRS) (0–2). Multivariate models were applied to estimate the effect of localization (BAO vs ACLVO). Results: In total, 2288 patients underwent TE for AIS with proximal vessel occlusion, of these 267 with BAO. Two hundred and sixty-four patients with BAO were matched to 264 patients with ACLVO. Baseline characteristics were well-balanced. The 90-day mortality did not significantly differ between patients with BAO and ACLVO. In a multivariate logistic regression model, we did not detect a significant difference in functional outcome between BAO and ACLVO (odds ratio for favorable outcome defined as mRS = 0–2: 1.19; 95% confidence interval (CI) = 0.78–1.81; p = 0.42). In patients with an onset-to-door-time ⩾270 min, TE of BAO was associated with poor functional outcome defined as mRS 3–6 (odds ratio (OR) = 3.97; 95% CI = 1.32–11.94; p = 0.01) as compared to ACLVO. Conclusion: In this study, functional outcome did not differ after TE in patients with BAO and ACLVO overall; however, we detected an association of BAO with poor outcome in patients arriving late.

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Early Neurological Deterioration Despite Recanalization in Basilar Artery Occlusion Treated by Endovascular Therapy

Cited by 7 publications

References 35 publications

Unexplained early neurological deterioration after endovascular treatment for acute large vessel occlusion: incidence, predictors, and clinical impact: Data from ANGEL-ACT registry

Unexplained early neurological deterioration after endovascular treatment for acute large vessel occlusion: incidence, predictors, and clinical impact: Data from ANGEL-ACT registry

Course of Early Neurologic Symptom Severity after Endovascular Treatment of Anterior Circulation Large Vessel Occlusion Stroke: Association with Baseline Multiparametric CT Imaging and Clinical Parameters

Thrombectomy in basilar artery occlusion

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