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Delayed neurological improvement after endovascular treatment for acute large vessel occlusion: data from ANGEL-ACT registry

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Abstract

Background

A subgroup of patients with acute large vessel occlusion (ALVO) may experience delayed neurological improvement (DNI) after endovascular treatment (EVT). Our study aimed to investigate the incidence and independent predictors of DNI in patients with ALVO after EVT.

Methods

We selected subjects from ANGEL-ACT Registry. The definition of DNI is patients with ALVO who did not experience early neurological improvement (ENI) despite complete recanalization after EVT. These patients achieved a 90-day favorable outcome assessed by a modified Rankin Scale (mRS) score. We defined ENI as a ≥ 4-point decrease in the National Institutes of Health Stroke Scale (NIHSS) between baseline and 24 h or NIHSS of 0 or 1 at 24 h, with complete recanalization after EVT. We performed logistic regression analyses to determine the independent predictors of DNI.

Results

Among the 1056 enrolled patients, 406 (38.4%) did not experience ENI. 106 (26.1%) patients without ENI achieved DNI. On Multivariate analysis, lower admission NIHSS score (odds ratio [OR] = 1.17,95% confidence interval [CI]: 1.11–1.23, P < 0.001), underlying ICAD (OR = 2.03, 95% CI: 1.07–3.85, P = 0.029) and absence of general anesthesia (OR = 2.13, 95% CI: 1.24–3.64, P = 0.006) were independent predictors of DNI.

Conclusion

DNI occurred in 26.1% of patients with ALVO who did not experience ENI after EVT. Our study identified several independent predictors of DNI that should be highly considered in daily clinical practice to improve ALVO management.

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Data availability

The data of this study are available from the corresponding author upon reasonable request.

References

  1. Prabhakaran S, Chen M, Choi JH et al (2008) Major neurologic improvement following endovascular recanalization therapy for acute ischemic stroke. Cerebrovasc Dis 25(5):401–407

    Article  PubMed  Google Scholar 

  2. Cao Y, Wang S, Sun W et al (2017) Prediction of favorable outcome by percent improvement in patients with acute ischemic stroke treated with endovascular stent thrombectomy. J Clin Neurosci 38:100–105

    Article  CAS  PubMed  Google Scholar 

  3. Heit JJ, Mlynash M, Kemp SM et al (2019) Rapid Neurologic Improvement Predicts Favorable Outcome 90 Days After Thrombectomy in the DEFUSE 3 Study. Stroke 50(5):1172–1177

    Article  PubMed Central  PubMed  Google Scholar 

  4. Alexandrov AV, Hall CE, Labiche LA, Wojner AW, Grotta JC (2004) Ischemic stunning of the brain: early recanalization without immediate clinical improvement in acute ischemic stroke. Stroke 35(2):449–452

    Article  PubMed  Google Scholar 

  5. Bang OY, Liebeskind DS, Saver JL et al (2011) Stunned brain syndrome: serial diffusion perfusion MRI of delayed recovery following revascularisation for acute ischaemic stroke. J Neurol Neurosurg Psychiatry 82(1):27–32

    Article  PubMed  Google Scholar 

  6. Desai SM, Tonetti DA, Morrison AA et al (2020) Delayed functional independence after thrombectomy: temporal characteristics and predictors. J Neurointerv Surg 12(9):837–841

    Article  PubMed  Google Scholar 

  7. Talavera B, Gomez-Vicente B, Martinez-Galdamez M et al (2021) Delayed Neurological Improvement After Full Endovascular Reperfusion in Acute Anterior Circulation Ischemic Stroke. Stroke 52(7):2210–2217

    Article  CAS  PubMed  Google Scholar 

  8. Jia B, Ren Z, Mokin M et al (2021) Current Status of Endovascular Treatment for Acute Large Vessel Occlusion in China: A Real-World Nationwide Registry. Stroke 52(4):1203–1212

    Article  CAS  PubMed  Google Scholar 

  9. Puetz V, Sylaja PN, Coutts SB et al (2008) Extent of hypoattenuation on CT angiography source images predicts functional outcome in patients with basilar artery occlusion. Stroke 39(9):2485–2490

    Article  PubMed  Google Scholar 

  10. Lee JS, Hong JM, Lee KS et al (2015) Endovascular Therapy of Cerebral Arterial Occlusions: Intracranial Atherosclerosis versus Embolism. J stroke Cerebrovasc diseases: official J Natl Stroke Association 24(9):2074–2080

    Article  Google Scholar 

  11. Zaidat OO, Yoo AJ, Khatri P, et al. Recommendations on angiographic revascularization grading standards for acute ischemic stroke: A consensus statement. Stroke. 2013;44(9):2650-2663

    Article  PubMed Central  PubMed  Google Scholar 

  12. von Kummer R, Broderick JP, Campbell BC et al (2015) The Heidelberg Bleeding Classification: Classification of Bleeding Events After Ischemic Stroke and Reperfusion Therapy. Stroke 46(10):2981–2986

    Article  Google Scholar 

  13. Soize S, Fabre G, Gawlitza M et al (2019) Can early neurological improvement after mechanical thrombectomy be used as a surrogate for final stroke outcome? J Neurointerv Surg 11(5):450–454

    Article  PubMed  Google Scholar 

  14. Weyland CS, Mokli Y, Vey JA et al (2021) Predictors for Failure of Early Neurological Improvement After Successful Thrombectomy in the Anterior Circulation. Stroke 52(4):1291–1298

    Article  CAS  PubMed  Google Scholar 

  15. Huo X, Ma N, Mo D et al (2019) Acute Ischaemic Stroke Cooperation Group of Endovascular Treatment (ANGEL) registry: study protocol for a prospective, multicentre registry in China. Stroke Vasc Neurol 4(1):57–60

    Article  PubMed Central  PubMed  Google Scholar 

  16. Lee D, Lee DH, Suh DC et al (2020) Endovascular Treatment in Patients with Cerebral Artery Occlusion of Three Different Etiologies. J Stroke 22(2):234–244

    Article  PubMed Central  PubMed  Google Scholar 

  17. Guglielmi V, LeCouffe NE, Zinkstok SM et al (2019) Collateral Circulation and Outcome in Atherosclerotic Versus Cardioembolic Cerebral Large Vessel Occlusion. Stroke 50(12):3360–3368

    Article  PubMed Central  PubMed  Google Scholar 

  18. Rebello LC, Bouslama M, Haussen DC et al (2017) Stroke etiology and collaterals: atheroembolic strokes have greater collateral recruitment than cardioembolic strokes. Eur J Neurol 24(6):762–767

    Article  CAS  PubMed  Google Scholar 

  19. Zotter M, Piechowiak EI, Balasubramaniam R et al (2021) Endovascular therapy in patients with large vessel occlusion due to cardioembolism versus large-artery atherosclerosis. Ther Adv Neurol Disord 14:1756286421999017

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Tan IY, Demchuk AM, Hopyan J et al (2009) CT angiography clot burden score and collateral score: correlation with clinical and radiologic outcomes in acute middle cerebral artery infarct. AJNR Am J Neuroradiol 30(3):525–531

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Borst J, Berkhemer OA, Santos EMM et al (2017) Value of Thrombus CT Characteristics in Patients with Acute Ischemic Stroke. AJNR Am J Neuroradiol 38(9):1758–1764

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  22. Yoo AJ, Khatri P, Mocco J et al (2017) Impact of Thrombus Length on Outcomes After Intra-Arterial Aspiration Thrombectomy in the THERAPY Trial. Stroke 48(7):1895–1900

    Article  PubMed  Google Scholar 

  23. Santos EM, Dankbaar JW, Treurniet KM et al (2016) Permeable Thrombi Are Associated With Higher Intravenous Recombinant Tissue-Type Plasminogen Activator Treatment Success in Patients With Acute Ischemic Stroke. Stroke 47(8):2058–2065

    Article  CAS  PubMed  Google Scholar 

  24. Menon BK, Al-Ajlan FS, Najm M et al (2018) Association of Clinical, Imaging, and Thrombus Characteristics With Recanalization of Visible Intracranial Occlusion in Patients With Acute Ischemic Stroke. JAMA 320(10):1017–1026

    Article  PubMed Central  PubMed  Google Scholar 

  25. Simonsen CZ, Yoo AJ, Sorensen LH et al (2018) Effect of General Anesthesia and Conscious Sedation During Endovascular Therapy on Infarct Growth and Clinical Outcomes in Acute Ischemic Stroke: A Randomized Clinical Trial. JAMA Neurol 75(4):470–477

    Article  PubMed Central  PubMed  Google Scholar 

  26. Campbell BCV, van Zwam WH, Goyal M et al (2018) Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data. Lancet Neurol 17(1):47–53

    Article  PubMed  Google Scholar 

  27. Messick JM Jr, Newberg LA, Nugent M, Faust RJ (1985) Principles of neuroanesthesia for the nonneurosurgical patient with CNS pathophysiology. Anesth Analg 64(2):143–174

    Article  PubMed  Google Scholar 

  28. Steen PA (1982) Inhalational versus intravenous anesthesia: cerebral effects. Acta Anaesthesiol Scand Suppl 75:32–35

    Article  CAS  PubMed  Google Scholar 

  29. Li F, Deshaies EM, Singla A et al (2014) Impact of anesthesia on mortality during endovascular clot removal for acute ischemic stroke. J Neurosurg Anesthesiol 26(4):286–290

    Article  PubMed  Google Scholar 

  30. Langner S, Khaw AV, Fretwurst T, Angermaier A, Hosten N, Kirsch M (2013) [Endovascular treatment of acute ischemic stroke under conscious sedation compared to general anesthesia - safety, feasibility and clinical and radiological outcome]. Rofo 185(4):320–327

    CAS  PubMed  Google Scholar 

  31. Brinjikji W, Pasternak J, Murad MH et al (2017) Anesthesia-Related Outcomes for Endovascular Stroke Revascularization: A Systematic Review and Meta-Analysis. Stroke 48(10):2784–2791

    Article  PubMed  Google Scholar 

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Funding

This Study funded by the National Key Research and Development Program of China, grant number 2016YFC1301500and China Postdoctoral Science Foundation, grant number 2020-YJ-008.

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Author notes

    Authors and Affiliations

    1. Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, 100070, Beijing, China

      Dapeng Sun, Raynald -, Xiaochuan Huo, Baixue Jia, Xu Tong, Gaoting Ma, Ning Ma, Feng Gao, Dapeng Mo & Zhongrong Miao

    2. Department of Neurosurgery , Beijing Fengtai You anmen Hospital , Beijing, China

      Raynald -

    3. China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

      Anxin Wang

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    1. Dapeng Sun
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    Correspondence to Zhongrong Miao.

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    Ethics approval

    This study was approved by the ethics committees of Beijing Tiantan Hospital, Capital Medical University. The ID of the approval: KY2017-048-01. Subjects or their legally authorized representatives provided written informed consent prior to commencing the study.

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    Dapeng Sun and Raynald contributed equally to this work.

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    Sun, D., -, R., Huo, X. et al. Delayed neurological improvement after endovascular treatment for acute large vessel occlusion: data from ANGEL-ACT registry. J Thromb Thrombolysis 55, 1–8 (2023). https://doi.org/10.1007/s11239-022-02712-7

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