Time Course and Clinical Relevance of Neurological Deterioration After Endovascular Recanalization Therapy for Anterior Circulation Large Vessel Occlusion Stroke.

Zibao Li,Zhiming Zhou,Qian Yang,Zhaohu Chu,Shoucai Zhao,Xianjun Huang,Jian Han,Hongchuan Zhang

doi:10.3389/fnagi.2021.651614

Abstract

Neurological deterioration (ND) is a devastating complication for patients with ischemic stroke after endovascular recanalization therapy (EVT). We aimed to investigate the time course and clinical relevance of ND after EVT. Consecutive patients with acute ischemic stroke who underwent EVT for large arterial occlusions of the anterior cerebral circulation were enrolled. The National Institutes of Health Stroke Scale (NIHSS) scores were assessed before EVT, at the end of EVT, at 24 h (d1), on day 3 (d3), on day 15 (d15), at discharge and anytime when ND was indicated. ND was defined as an increase of ≥ 4 points in the NIHSS score and was divided into acute ND (AD, within 24 h), subacute ND (SD, d1–d3), and delayed ND (DD, d3–d15 or discharge). Using multivariable logistic regression analysis, we explored predictors and outcomes of ND at different time periods. As a result, of 343 patients, 129 (37.6%) experienced ND, including 90 (26.2%) with AD, 27 (7.9%) with SD and 12 (3.5%) with DD. Multivariable logistic regression analysis revealed that history of hypertension, cardioembolic stroke, lower Alberta Stroke Program Early Computed Tomography Score (ASPECTS), and poor collaterals were significantly associated with an increased risk of AD; history of hypertension, lower ASPECTS, poor collaterals, and unsuccessful recanalization, with SD; and high admission NIHSS score, with DD. In addition, patients who experienced AD (OR = 10.22, P < 0.001), SD (OR = 15.89, P = 0.004), or DD (OR = 8.31, P = 0.015) were more likely to have poor outcomes. ND was a strong predictor of poor stroke outcomes. Management of related risk factors at different ND time periods might improve the prognosis of EVT.

Highlights

With the aging of global population, stroke has become the second leading cause of disabilityadjusted life-years (DALYs) for older adults underlying the need to deal with disabling outcome (GBD 2019 Diseases and Injuries Collaborators, 2020)
Our study demonstrated that 37.6% of stroke patients experienced neurological deterioration (ND) after endovascular recanalization therapy (EVT) during hospitalization, especially in the first 24 h
We revealed a striking association between ND at different time periods (AD, SD, and DD) and poor prognosis

Summary

Introduction

With the aging of global population, stroke has become the second leading cause of disabilityadjusted life-years (DALYs) for older adults underlying the need to deal with disabling outcome (GBD 2019 Diseases and Injuries Collaborators, 2020). Time Course of Neurological Deterioration patients with large arterial occlusion strokes in anterior cerebral circulation (Berkhemer et al, 2015; Campbell et al, 2015; Goyal et al, 2015; Jovin et al, 2015; Saver et al, 2015). Individual responses to EVT vary widely and clinical evolution is largely unpredictable. Previous studies had already suggested that early neurological deterioration (ND) predicted poor functional outcomes after EVT (Zhang et al, 2018; Kim et al, 2019a). The perioperative management of patients with EVT is a continuous and refined process during hospital. The incidence, predictors, and outcomes of ND in different time periods might be different. Study of ND in different time periods after EVT contributed to a better individualized management

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