Unexplained early neurological deterioration after endovascular treatment for acute large vessel occlusion: incidence, predictors, and clinical impact: Data from ANGEL-ACT registry.
retrospective_cohort · Level III
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- Record sourced from PubMed, PMID 34593600.
- Also identified by DOI 10.1136/neurintsurg-2021-017956.
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Abstract
Early 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 (END<sub>unexplained</sub>), exists. We aimed to investigate the incidence, independent predictors, and clinical impact of END<sub>unexplained</sub> after EVT in patients with acute LVO. Subjects were selected from the ANGEL-ACT registry. END<sub>unexplained</sub> 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 END<sub>unexplained</sub>, as well as the association between END<sub>unexplained</sub> and 90-day outcomes assessed by modified Rankin Scale (mRS) score. Among the 1557 enrolled patients, the incidence of END<sub>unexplained</sub> 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 END<sub>unexplained</sub>. Furthermore, patients with END<sub>unexplained</sub> 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). END<sub>unexplained</sub> associated with poor 90day outcomes occurred in 4.3% of patients with acute LVO undergoing EVT. Several independent predictors of END<sub>unexplained</sub> were identified in this study, which should be considered in daily practice to improve acute LVO management. http://wwwclinicaltrialsgov NCT03370939.
Medical subject headings
- Brain Ischemia
- Endovascular Procedures
- Stroke