Early neurological deterioration after endovascular treatment for acute stroke with mild symptoms.

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Endovascular treatment (EVT) for acute ischemic stroke (AIS) with mild symptoms (National Institute of Health Stroke Scale [NIHSS] score of ≤ 5) has a specific concern about early neurological deterioration (END) after the procedure, but its significance remains unclear. This study aims to examine the prognostic impact and characteristics of END in this patient population. We conducted a post-hoc analysis of the Japan Registry of NeuroEndovascular Therapy 4, enrolling 13,479 patients who underwent EVT for AIS at 166 participating centers between 2015 and 2019. We included patients with AIS and NIHSS scores ≤ 5 and compared outcomes (modified Rankin Scale [mRS] score at 30 days) between patients with and without END after EVT. Multivariate logistic regression models were used to explore associations between END and outcomes and risk factors for END. Of 503 patients analyzed, 66 (13%) developed END. Patients who developed END had a lower proportion of mRS scores of 0-2 at 30 days than the No-END group (17% vs. 80%, P < 0.0001), with an adjusted odds ratio (OR) of 0.04 (95% confidence interval [CI], 0.02-0.11). Mortality within 30 days was higher among patients with END (9.1% vs. 0.7%, P < 0.0001). A multivariable logistic regression model identified that factors associated with END included age ≥ 75 years (adjusted OR 3.67; 95% CI, 1.78-7.55), ASPECTS (adjusted OR 0.82; 95% CI, 0.69-0.97), NIHSS scores before EVT of 0-2 compared with those of 3-5 (adjusted OR 2.11; 95% CI, 1.04-4.25), and unsuccessful recanalization (adjusted OR 8.39; 95% CI, 3.90-18.0). END after EVT for AIS with mild symptoms was relatively common and associated with worse outcomes. Risk stratification for END and successful recanalization would be crucial, particularly for EVT candidates with mild symptoms.