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Incidence and mechanism of early neurological deterioration after endovascular thrombectomy

  • Jeong-Min Kim
  • Jae-Han Bae
  • Kwang-Yeol ParkEmail author
  • Woong Jae Lee
  • Jun Soo Byun
  • Suk-Won Ahn
  • Hae-Won Shin
  • Su-Hyun Han
  • Il-Han Yoo
Original Communication
  • 35 Downloads

Abstract

Background

We investigated the prevalence and mechanisms of neurological deterioration after endovascular thrombectomy.

Methods

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.

Results

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.

Conclusion

Neurological deterioration frequently occurs after endovascular thrombectomy, and the risk factors of END differ according to the mechanism of END.

Keywords

Stroke Mechanical thrombectomy Prognosis 

Notes

Acknowledgements

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.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NeurologyChung-Ang University Hospital, Chung-Ang University College of Medicine, SeoulSeoulSouth Korea
  2. 2.Department of NeuroradiologyChung-Ang University Hospital, Chung-Ang University College of MedicineSeoulSouth Korea

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