Predictors of Unexplained Early Neurological Deterioration After Endovascular Treatment for Acute Ischemic Stroke
Jean-Baptiste Girot, Sébastien Richard, Florent Gariel, Igor Sibon, Julien Labreuche, Maéva Kyheng, Benjamin Gory, Cyril Dargazanli, Benjamin Maïer, Arturo Consoli, Benjamin Daumas-Duport, Bertrand Lapergue, Romain Bourcier, Michel Piotin, Raphaël Blanc, Hocine Redjem, Simon Escalard, Jean‐Philippe Desilles, Gabriele Cicciò, Stanislas Smajda, Mikaël Mazighi, Mikael Obadia, Candice Sabben, Roxanne Peres, Ovide Corabianu, T. de Broucker, Didier Smadja, Sonia Alamowitch, Olivier Ille, Eric Manchon, Pierre‐Yves Garcia, Guillaume Taylor, Malek Ben Maacha, Adrien Wang, Serge Evrard, Maya Tchikviladzé, Nadia Ajili, David Weisenburger, Lucas Gorza, Géraldine Buard, Oguzhan Coskun, Federico Di Maria, Georges Rodesh, Sergio Zimatore, Morgan Leguen, Julie Gratieux, Fernando Pico, Haja Rakotoharinandrasana, Philippe Tassan, Roxanna Poll, Sylvie Marinier, Norbert Nighoghossian, Roberto Riva, Omer Eker, Françis Turjman, Laurent Derex, Tae‐Hee Cho, Laura Mechtouff, Anne Claire Lukaszewicz, Frédéric Philippeau, Serkan Cakmak, Karine Blanc‐Lasserre, Anne‐Evelyne Vallet, Gaultier Marnat, Xavier Barreau, Jérôme Berge, Louis Veunac, Patrice Ménégon, Ludovic Lucas, Stéphane Olindo, Pauline Renou, Sharmila Sagnier, Mathilde Poli, Sabrina Debruxelles, Thomas Tourdias et Jean-Sebastien Liegey, Lili Détraz, Pierre-Louis Alexandre, Monica Roy, Cédric Lenoble, Vincent L’Allinec, Hubert Desal, Benoît Guillon, Solène de Gaalon, Cécile Preterre, Serge Bracard, René Anxionnat, Marc Braun, Anne‐Laure Derelle, Romain Tonnelet, Liang Liao, François Zhu, Emmanuelle Schmitt, Sophie Planel, Lisa Humbertjean, Gioia Mione, Jean‐Christophe Lacour, Mathieu Bonnerot, Nolwenn Riou-Comte, Francisco Macian-Montoro, Suzanna Saleme
Abstract
BACKGROUND AND PURPOSE: Although the efficacy of endovascular treatment (EVT) in patients with anterior circulation ischemic stroke (AIS) is well documented, early neurological deterioration after EVT remains a serious issue associated with poor outcome. Besides obvious causes, such as lack of reperfusion, procedural complications, or parenchymal hemorrhage, early neurological deterioration may remain unexplained (UnEND). Our aim was to investigate predictors of UnEND after EVT in patients with AIS. METHODS: Patients who underwent EVT for AIS, with an initial National Institutes of Health Stroke Scale score >5, Alberta Stroke Program Early CT Score ≥6, and included in a multicenter prospective observational registry were analyzed. Predictors of UnEND, defined as ≥4-point increase in the National Institutes of Health Stroke Scale score between baseline and day 1 after EVT, were determined via center-adjusted analyses. RESULTS: Among the 1925 included in the analysis, 128 UnEND (6.6%) were recorded. In multivariate analysis, predictors of UnEND were diabetes mellitus (odds ratio [OR], 2.17 [95% CI, 1.32-3.56]), prestroke modified Rankin Scale score ≥2 (OR, 2.22 [95% CI, 1.09-4.55]), general anesthesia (OR, 2.55 [95% CI, 1.51-4.30]), admission systolic blood pressure (OR, 1.10 [95% CI, 1.01-1.20]), age (OR, 1.38 [95% CI, 1.14-1.67]), number of passes (OR, 1.16 [95% CI, 1.04-1.28]), direct admission or not to a comprehensive stroke center (OR, 0.49 [95% CI, 0.30-0.81]), and initial National Institutes of Health Stroke Scale score (OR, 0.65 [95% CI, 0.52-0.81]). CONCLUSIONS: Severely impaired AIS patients with nonmodifiable factors are more likely to develop UnEND. Some modifiable predictors of UnEND such as the number of EVT passes could be the object of improvement in AIS management.