Prediction of Early Neurological Deterioration in Individuals With Minor Stroke and Large Vessel Occlusion Intended for Intravenous Thrombolysis Alone

Pierre Seners ¹, Wagih Ben Hassen ², Bertrand Lapergue ³

⁰Neurology Department, GHU Paris psychiatrie et neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université de Paris, FHU Neurovasc, Paris, France.

Jama Neurology +

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January 11, 2021

View abstract on PubMed

Summary

A new score predicts early neurological deterioration (ENDi) in minor stroke patients with large vessel occlusion (LVO) after IV thrombolysis. This helps identify candidates for thrombectomy, improving stroke reperfusion strategies.

Area Of Science

Neurology
Stroke Medicine
Interventional Neurology

Background

Optimal reperfusion strategies for acute minor stroke with large vessel occlusion (LVO) remain unclear.
Predicting early neurological deterioration of presumed ischemic origin (ENDi) after intravenous thrombolysis (IVT) is crucial for patient selection for thrombectomy.

Purpose Of The Study

To develop and validate a simple predictive score for ENDi in minor stroke patients receiving IVT for LVO.

Main Methods

A multicentric retrospective cohort study involving 729 patients with minor stroke and LVO treated with IVT.
External validation was performed on a separate cohort of 347 patients.
A 4-point score was derived based on occlusion site and thrombus length.

Main Results

ENDi occurred in 12.1% of the derivation cohort and was associated with poorer outcomes.
Proximal occlusion site and longer thrombus length were independent predictors of ENDi.
The derived score demonstrated good discriminative power (C-statistic=0.76) and was validated externally (C-statistic=0.78).

Conclusions

The study highlights significant rates of ENDi in minor stroke patients with LVO treated with IVT.
An easily applicable score for ENDi risk prediction was developed and validated.
This score may aid in decision-making regarding immediate transfer for thrombectomy.

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