Early neurological deterioration following thrombolysis for minor stroke with isolated internal carotid artery occlusion

Boulenoir, Naouel; Turc, Guillaume; Hénon, Hilde; Laksiri, Nadia; Mounier‐Véhier, F.; Buttaz, Isabelle Girard; Duong, Duc-Long; Papassin, Jérémie; Yger, Marion; Triquenot, Aude; Lyoubi, Aïcha; Schiphorst, Adrien Ter; Denier, Christian; Baron, Jean‐Claude; Seners, Pierre; Hassen, Wagih Ben; Lapergue, Bertrand; Lamy, Chantal; Lucas, Ludovic; Philippeau, Frédéric; Obadia, Michaël; Piotin, Michel; Bennani, O.; Mechtouff, Laura; Klapczynski, Frédéric; Detante, Olivier; Arquizan, Caroline; Mione, Gioia; Sablot, Denis; Debiais, Séverine; Cakmak, Serkan; Grigoras, Valer; Tamazyan, Ruben; Preterre, Cécile; Rosso, Charlotte; Niclot, Philippe; Garnier, P.; Soize, Sébastien; Lun, François; Tuffal, Amélie; Boulanger, Marion; Gazzola, Sébastien; Zuber, Mathieu; Pico, Fernando; Clarençon, Frédéric; Sibon, Igor; Alamowitch, Sonia; Fraticelli, Laurie; Vallet, Anne‐Evelyne; Costalat, Vincent; Oppenheim, Catherine; Cottier, Jean‐Philippe; Berthezène, Yves; Desal, Hubert; Agius, Pierre; Billen, Claire; Bricout, Nicolas; Leys, Didier; Chbicheb, Mohamed; Malbranque, Arnaud; Spelle, Laurent; Bracard, Serge; Masson, Mylène

doi:10.1111/ene.14541

Cited by 35 publications

(37 citation statements)

References 26 publications

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“…PLR had a specificity of 73.0% and a sensitivity of 56.4% for predicting END. For END was a composite outcome that includes initial NIHSS, it was speculated he NIHSS was associated with END, and we did obtain that NIHSS was independently related to END at admission, which was consistent with the conclusion of Boulenoir et al (2020).…”

Section: Discussionsupporting

confidence: 91%

Early neurological deterioration in cardiogenic cerebral embolism due to nonvalvular atrial fibrillation: Predisposing factors and clinical implications

Liu

2020

Brain and Behavior

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Purpose The aim of the study was to investigate factors which may predispose patients to early neurological deterioration (END) and explore peripheral biomarkers for the prediction of END in cardiogenic cerebral embolism (CCE) patients. Methods Patients diagnosed with CCE within 24 hr of onset between January 2017 and January 2019 were included in this study. END was defined as an increase of ≥2 on the National Institutes of Health Stroke Scale (NIHSS) or the emergence of new neurological symptoms within 3 days of admission. Binary logistic regression was used to investigate the factors associated with END. Receiver operating characteristic (ROC) curves were then generated to determine the predictive value of the potential biomarkers and the optimal cutoff values. Results Of the 129 (male, 55.81%; mean age 71.85 ± 11.99 years) CCE patients, 55 patients with END were identified. Hemorrhage transformation (HT), coronary heart disease (CHD), diastolic blood pressure, cystatin C levels, NIHSS score, and platelet‐to‐lymphocyte ratio (PLR) at admission were independently associated with END. A peripheral cystatin C level ≥ 1.41 mg/L and a PLR ≥ 132.97 were predictive factors for END in CCE patients. The lymphocyte‐to‐monocyte ratio (LMR) was negatively independently associated with HT, and LMR < 2.31 may predict the occurrence of HT in patients with CCE. Conclusions Of the potential predisposing factors considered, increased cystatin C and PLR were associated with END within 3 days of CCE, and a decreased LMR may have predictive value for HT in CCE patients.

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Section: Discussionsupporting

confidence: 91%

Early neurological deterioration in cardiogenic cerebral embolism due to nonvalvular atrial fibrillation: Predisposing factors and clinical implications

Liu

2020

Brain and Behavior

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“…Our study showed that the prevalence of post-thrombolysis END and post-thrombolysis ENI were 18.2% as well as 37.5%, respectively. These prevalence are in line with the previous researches [25][26][27][28][29]. In this observational study, we found NLR as well as PLR were associated with post-thrombolysis END.…”

Section: Discussionsupporting

confidence: 92%

“…In case of disagreement about the NIHSS score evaluation, a third neurologist in this center was invited for a nal decision. Post-thrombolysis END was de ned as an increase in the NIHSS score by ≥ 4 points in the total score within 24 hours after thrombolysis [7,24,25].Meanwhile, post-thrombolysis ENI was de ned as a decrease in the NIHSS score by ≥ 4 points in the total score or a complete resolution of neurological de cits within 24 hours after thrombolysis [26][27][28].…”

Section: De Nition Of Post-thrombolysis Early Neurological Deterioratmentioning

confidence: 99%

The Association of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Lymphocyte-Monocyte Ratio With Post-Thrombolysis Early Neurological Outcomes in Patients With Acute Ischemic Stroke

Gong

Liu

Gong

et al. 2020

Preprint

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Background and Purpose: To investigate the association of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) with post-thrombolysis early neurological outcomes including early neurological improvement (ENI) and early neurological deterioration (END) in patients with acute ischemic stroke (AIS).Methods: AIS patients undergoing intravenous thrombolysis were enrolled from April 2016 to September 2019. Blood cell counts were sampled before thrombolysis. Post-thrombolysis END was defined as National Institutes of Health Stroke Scale (NIHSS) score increase of ≥4 within 24 hours after thrombolysis. Post-thrombolysis ENI was defined as NIHSS score decrease of ≥4 or complete recovery within 24 hours. Multivariable logistic regression analyses were performed to explore the relationship of NLR, PLR and LMR to post-thrombolysis END and ENI. We also used receiver operating characteristic curve analysis to assess the discriminative ability of three ratios in predicting END and ENI.Results: Among 1060 recruited patients, a total of 193 (18.2%) were diagnosed with ENI and 398 (37.5%) were diagnosed with END. Multivariable logistic models indicated that NLR (odds ratio [OR], 1.652; 95% confidence interval [CI] 1.510-1.807, P=0.001) and PLR (OR, 1.015; 95% CI 1.012-1.018, P=0.001) were independent factors for post-thrombolysis END. Moreover, NLR (OR, 0.686; 95% CI 0.631-0.745, P=0.001), PLR (OR, 0.997; 95% CI 0.994-0.999, P=0.006) and LMR (OR, 1.170; 95% CI 1.043-1.313, P=0.008) served as independent factors for post-thrombolysis ENI. Area under curve (AUC) of NLR, PLR and LMR to discriminate END were 0.763, 0.703 and 0.551, respectively. AUC of NLR, PLR and LMR to discriminate ENI were 0.695, 0.530 and 0.547, respectively.Conclusions: NLR and PLR were associated with and may predict post-thrombolysis END. NLR, PLR and LMR were related to post-thrombolysis ENI.

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“…Although we did not assess this association further, existing results have shown that thrombolysis may be associated with potential harm in patients presenting with an NIHSS score of 0-1 compared to patients with a score of 2-5 (21). Other results suggested that intravenous thrombolysis might also be associated with deterioration due to thrombus fragmentation in some patients with ICA occlusion (22). The efficacy of bridging thrombolysis in those patients also remains to be elucidated (23).…”

Section: Discussionmentioning

confidence: 89%

Acute Stroke With Large Vessel Occlusion and Minor Clinical Deficits: Prognostic Factors and Therapeutic Implications

et al. 2021

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Background and Purpose: The optimal acute management of patients with large vessel occlusion (LVO) and minor clinical deficits on admission [National Institutes of Health Stroke Scale (NIHSS) ≤ 4] remains to be elucidated. The aim of the present study was to investigate the prognostic factors and therapeutic management of those patients.Methods: In this retrospective cohort study, we investigated (1) all patients with acute ischemic stroke due to an LVO who underwent mechanical thrombectomy (MT) and (2) all patients with minor clinical deficits (NIHSS ≤ 4) on admission due to an LVO between January 2013 and December 2016 at the University Medical Center Erlangen. We dichotomized management of patients with minor deficits treated with MT for analysis according to immediate mechanical thrombectomy (IT) and initial medical management with rescue intervention (MM) in case of secondary deterioration. Primary endpoints were secondary deterioration, in-hospital mortality, and functional outcome on day 90 (dichotomized modified Rankin Scale 0–2: favorable, 3–6: poor).Results: Two hundred twenty-three patients (83% with anterior circulation stroke, 13 (6%) with minor deficits) treated with MT and 88 patients with minor deficits due to LVO [13 (15%) treated with MT] were included. Secondary deterioration (n = 19) was independently associated with poor outcome in patients with minor deficits and LVO [odds ratio (OR), 0.060; 95% confidence interval (CI), 0.013–0.280], which in turn was associated with the occlusion site [especially M1 occlusion: 11 (58%) vs. 3 (4%) in patients without secondary deterioration, p < 0.0001]. IT (n = 8) was associated with a lower intrahospital mortality compared to MM (n = 5; 13 vs. 80%; OR, 0.036; 95% CI, 0.002–0.741). Seven of eight patients with IT survived until discharge, with 29% showing a favorable functional outcome on day 90.Conclusions: Secondary deterioration is associated with poor outcome in patients with LVO and minor deficits, which in turn was associated with occlusion site. Future randomized controlled trials should assess whether selected patients, depending on occlusion site and associated characteristics, may benefit from MT.

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Early neurological deterioration following thrombolysis for minor stroke with isolated internal carotid artery occlusion

Cited by 35 publications

References 26 publications

Early neurological deterioration in cardiogenic cerebral embolism due to nonvalvular atrial fibrillation: Predisposing factors and clinical implications

Early neurological deterioration in cardiogenic cerebral embolism due to nonvalvular atrial fibrillation: Predisposing factors and clinical implications

The Association of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Lymphocyte-Monocyte Ratio With Post-Thrombolysis Early Neurological Outcomes in Patients With Acute Ischemic Stroke

Acute Stroke With Large Vessel Occlusion and Minor Clinical Deficits: Prognostic Factors and Therapeutic Implications

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