Neurological improvement predicts clinical outcome after acute basilar artery stroke thrombectomy

Guenego, Adrien; Bourcier, Romain; Guillen, Maud; Weisenburger‐Lile, David; Lapergue, Bertrand; Gory, Benjamin; Richard, Sébastien; Ducroux, Célina; Piotin, Michel; Blanc, Raphaël; Labreuche, Julien; Lucas, Ludovic; Détraz, Lili; Aubertin, Mathilde; Dargazanli, Cyril; Benali, Amel; Vannier, Stéphane; Eugène, François; Lun, Ronda; Walker, Gregory; Consoli, Arturo; Fahed, Robert; Investigators, Etis

doi:10.1111/ene.14487

Cited by 15 publications

(16 citation statements)

References 23 publications

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“…Early neurological improvement (ENI) is a strong predictor of favorable clinical outcome in anterior-circulation strokes in both early ( 1 – 4 , 14 , 15 , 19 – 21 ) and late time windows ( 5 ) and in basilar artery occlusions ( 6 ). Our study shows similar findings in patients with DMVO, suggesting that ENI is a strong independent predictor of improved clinical outcome with all conventional mRS dichotomizations.…”

Section: Discussionmentioning

confidence: 99%

“…The rate of ENI has been reported to occur in 28 ( 2 ) to 33% of patients after administration of IVtPA, 35% ( 20 ) after intra-arterial thrombolytic therapy, up to 43% ( 21 ) after MT for anterior circulation strokes within the 6 h window, and in 30% of basilar occlusions ( 6 ). We identified ENI in 39% of our cohort, which included a diverse array of patients.…”

Section: Discussionmentioning

confidence: 99%

“…Early neurological improvement (ENI) was defined as already published: a reduction of 8 points or more on the National Institutes of Health Stroke Scale (NIHSS) or an NIHSS score of 0 or 1 at 24 h after MT ( 1 , 2 , 5 , 6 , 14 , 15 ).…”

Section: Methodsmentioning

confidence: 99%

“…It has been demonstrated that early neurological improvement (ENI) after mechanical thrombectomy (MT) or administration of Intravenous tissue Plasminogen Activator (IVtPA) for an anterior acute ischemic stroke (AIS) is a solid predictor of favorable long-term outcome ( 1 – 4 ). This is also applicable in late time windows ( 5 ) and for basilar artery occlusions ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

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Early Neurological Improvement Predicts Clinical Outcome After Thrombectomy for Distal Medium Vessel Occlusions

et al. 2022

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Background and PurposeGood clinical outcome predictors have been established in mechanical thrombectomy (MT) for acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). An early neurological improvement (ENI), defined as a reduction of ≥8 on the National Institutes of Health Stroke Scale (NIHSS), compared with the baseline score or an NIHSS of 0 or 1 at 24 h after MT, is a strong predictor of favorable outcome. We aimed to study the impact of ENI after MT for distal medium vessel occlusions (DMVO).MethodsWe retrospectively analyzed the data of consecutive patients who underwent MT for a primary DMVO in one large academic center. We compared clinical outcomes between patients with DMVO stratified by ENI. Multivariate analyses were performed to determine the impact of ENI on good 90-day outcome (modified Rankin scale of 0–2) and identify factors contributing to ENI.ResultsBetween January 2018 and January 2021, 61 patients underwent an MT for an AIS with a primary DMVO. An ENI was seen in 24 (39%) patients (ENI+). Outcomes were significantly better in ENI+ patients, with 83% achieving a good outcome at 3 months vs. 43% for patients without ENI (ENI–; p = 0.019). ENI was an independent predictive factor of good clinical outcome even after adjusting for potential confounding factors [odds ratio 12.49 (1.49–105.01), p = 0.020]. The use of intravenous tissue plasminogen activator [IVtPA; Odds-ratio 6.59 (1.82–23.89), p = 0.004] was a positive predictor of ENI.ConclusionENI at day 1 following MT for DMVO stroke is a strong independent predictor of good to excellent 3-month clinical outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Early Neurological Improvement Predicts Clinical Outcome After Thrombectomy for Distal Medium Vessel Occlusions

et al. 2022

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“…sICH was defined as a newly observed intracranial hemorrhage leading to an increase of four points on the NIHSS before worsening or an increase of two points in one category (Liu et al, 2020;Writing Group for the BASILAR Group et al, 2020). Early neurological improvement (ENI) was defined as a reduction of the NIHSS score from the baseline score of >8, or a return to 0, 24 h after EVT (Guenego et al, 2021).…”

Section: Procedures and Data Collectionmentioning

confidence: 99%

Severe Brain Atrophy Predicts Poor Clinical Outcome After Endovascular Treatment of Acute Basilar Artery Occlusion: An Automated Volumetric Analysis of a Nationwide Registry

Liu

et al. 2021

Front. Aging Neurosci.

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Background: Brain atrophy globally reflects the effects of preexisting risk factors and biological aging on brain structures and normally predicts poor outcomes in anterior circulation stroke. However, comparing with these patients, acute basilar artery occlusion (ABAO) impairs infratentorial regions frequently and might benefit from brain atrophy due to the resulting residual space to reduce tissue compression and thus improve prognosis, which raises doubts that current understandings for prognostic roles of brain atrophy are also applicable for ABAO. Therefore, this study aims to evaluate brain atrophy automatically from CT images and investigates its impact on outcomes of ABAO following endovascular treatment (EVT).Methods: A total of 231 ABAO who underwent EVT from the BASILAR registry were enrolled. Brain atrophy was quantified as the ratio of brain parenchymal volume to cerebrospinal fluid volume on baseline CT. The primary outcome was the modified Rankin Scale (mRS) score at 3 months.Results: The frequency of favorable outcomes (90-day mRS ≤ 3) was significantly lower in the severe atrophy group (P = 0.014). Adjusted logistic models revealed that severe brain atrophy was significantly negatively associated with favorable outcome incidence (P = 0.006), with no relationship with either in-hospital or 90-day overall mortality (all P > 0.05). Adding a severe atrophy index into the baseline model obviously enhanced its discriminatory ability in predicting the outcome by obviously increasing areas under the receiver operating characteristic curve, net reclassification improvement algorithm, and integrated discrimination improvement algorithm values (all P < 0.05).Conclusion: Severe brain atrophy did not improve in-hospital or overall mortality but impaired the long-term recovery after EVT. This objective and automated marker has the potential to be incorporated into decision-support methods for treating ABAO.

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Dynamic and visual nomograms to online predict unfavorable outcome of mechanical thrombectomy for acute basilar artery occlusion

Pan,

Lin,

Xiang

et al. 2023

Brain and Behavior

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BackgroundThe evidence of mechanical thrombectomy (MT) in basilar artery occlusion (BAO) was limited. This study aimed to develop dynamic and visual nomogram models to predict the unfavorable outcome of MT in BAO online.MethodsBAO patients treated with MT were screened. Preoperative and postoperative nomogram models were developed based on clinical parameters and imaging features. An independent dataset was collected to perform external validation. Web‐based calculators were constructed to provide convenient access.ResultsA total of 127 patients were included in the study, and 117 of them were eventually included in the analysis. The nomogram models showed robust discrimination, with an area under the receiver operating characteristic (ROC) of 0.841 (preoperative) and 0.916 (postoperative). The calibration curves showed good agreement. The preoperative predictors of an unfavorable outcome were previous stroke, the National Institutes of Health Stroke Scale (NIHSS) at admission, and the posterior circulation Alberta Stroke Program Early Computed Tomography Score (pc‐ASPECTS). The postoperative predictors were previous stroke, NIHSS at 24 h, and pc‐ASPECTS.ConclusionDynamic and visual nomograms were constructed and validated for the first time for BAO patients treated with MT, which provided precise predictions for the risk of an unfavorable outcome. The preoperative model may assist clinicians in selecting eligible patients, and the postoperative model may facilitate individualized poststroke management.

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Neurological improvement predicts clinical outcome after acute basilar artery stroke thrombectomy

Abstract: Early neurological improvement on day 1 following thrombectomy for basilar artery occlusion is a strong independent predictor of a favorable 3‐month clinical outcome.

Cited by 15 publications

References 23 publications

Early Neurological Improvement Predicts Clinical Outcome After Thrombectomy for Distal Medium Vessel Occlusions

Early Neurological Improvement Predicts Clinical Outcome After Thrombectomy for Distal Medium Vessel Occlusions

Severe Brain Atrophy Predicts Poor Clinical Outcome After Endovascular Treatment of Acute Basilar Artery Occlusion: An Automated Volumetric Analysis of a Nationwide Registry

Dynamic and visual nomograms to online predict unfavorable outcome of mechanical thrombectomy for acute basilar artery occlusion

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