Incidence and mechanism of early neurological deterioration after endovascular thrombectomy
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We investigated the prevalence and mechanisms of neurological deterioration after endovascular thrombectomy.
Between January 2011 and October 2017, acute ischemic stroke patients treated by endovascular thrombectomy in a tertiary university hospital were included. Early neurological deterioration (END) was defined as an increase of 2 or more National Institute of Health Stroke Scale (NIHSS) compared to the best neurological status after stroke within 7 days. The END mechanism was categorized into ischemia progression, symptomatic hemorrhage, and brain edema.
A total of 125 acute ischemic stroke patients received endovascular thrombectomy. Neurological deterioration was detected in 44 patients, and 38 cases (86.4% of END) occurred within 72 h. The END mechanism included 20 ischemia progression, 16 brain edema and 8 hemorrhagic transformation cases. Multivariable logistic regression analysis revealed that the patients who experienced END were more likely to have poor functional outcome defined as modified Rankin scale 3–6 at 90 days than neurologically stable patients (odds ratio (OR) = 4.06, confidence interval (CI) = 1.39–11.9). The risk factor of END due to ischemia progression was stroke subtype of large artery atherosclerosis (OR = 6.28, CI = 1.79–22.0). Successful recanalization (OR = 0.11, CI = 0.03–0.39) and NIHSS after endovascular thrombectomy (OR = 1.15 per one-point increase, CI = 1.06–1.24) were significantly associated with END due to hemorrhage or brain edema.
Neurological deterioration frequently occurs after endovascular thrombectomy, and the risk factors of END differ according to the mechanism of END.
KeywordsStroke Mechanical thrombectomy Prognosis
The work was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2016R1D1A1B03933891). The funding has no role in the design, collection, analysis, or interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication.
Compliance with ethical standards
Conflicts of interest
All the authors declare that they have no conflict of interest.
- 7.Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC et al (2015) 2015 American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 46:3020–3035CrossRefGoogle Scholar