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Published on: April 21, 2017
Early neurological deterioration in patients with minor stroke due to isolated M2 occlusion undergoing medical
Aldobrando Broccolini1,2, Valerio Brunetti3, Francesca Colò2
1Neurology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy aldobrando.broccolini@policlinicogemelli.it.
Background:
Patients with minor stroke and M2 occlusion undergoing best medical management (BMM) may face early neurological deterioration (END) that can lead to poor long-term outcome. In case of END, rescue mechanical thrombectomy (rMT) seems beneficial. Our study aimed to define factors relevant to clinical outcome in patients undergoing BMM with the possibility of rMT on END, and find predictors of END.
Methods:
Patients with M2 occlusion and a baseline National Institutes of Health Stroke Scale (NIHSS) score≤5 that received either BMM only or rMT on END after BMM were extracted from the databases of 16 comprehensive stroke centers. Clinical outcome measures were a 90-day modified Rankin Scale (mRS) score of 0-1 or 0-2, and occurrence of END.
Results:
Among 10 169 consecutive patients with large vessel occlusion admitted between 2016 and 2021, 208 patients were available for analysis. END was reported in 87 patients that were therefore all subjected to rMT. In a logistic regression model, END (OR 3.386, 95% CI 1.428 to 8.032), baseline NIHSS score (OR 1.362, 95% CI 1.004 to 1.848) and a pre-event mRS score=1 (OR 3.226, 95% CI 1.229 to 8.465) were associated with unfavorable outcome. In patients with END, successful rMT was associated with favorable outcome (OR 4.549, 95% CI 1.098 to 18.851). Among baseline clinical and neuroradiological features, presence of atrial fibrillation was a predictor of END (OR 3.547, 95% CI 1.014 to 12.406).
Conclusion:
Patients with minor stroke due to M2 occlusion and atrial fibrillation should be closely monitored for possible worsening during BMM and, in this case, promptly considered for rMT.
Insights
Patients with minor stroke and M2 occlusion experiencing early neurological deterioration (END) may benefit from rescue mechanical thrombectomy (rMT). Atrial fibrillation is a predictor of END, necessitating close monitoring and prompt rMT consideration.
Area of Science:
- Neurology
- Interventional Neurology
- Stroke Medicine
Background:
- Minor stroke with M2 occlusion can lead to early neurological deterioration (END) despite best medical management (BMM).
- Rescue mechanical thrombectomy (rMT) may be beneficial in cases of END.
- Identifying predictors of END and factors influencing outcomes is crucial for optimizing treatment strategies.
Purpose of the Study:
- To identify factors associated with clinical outcomes in patients with M2 occlusion undergoing BMM with the option of rMT for END.
- To determine predictors of END in this patient population.
Main Methods:
- Retrospective analysis of 208 patients with M2 occlusion and baseline NIHSS score ≤5 from 16 stroke centers (2016-2021).
- Patients received either BMM alone or rMT upon END.
- Outcomes included 90-day mRS scores (0-1 or 0-2) and occurrence of END.
Main Results:
- END occurred in 87 patients, all of whom underwent rMT.
- END, higher baseline NIHSS, and pre-event mRS=1 were associated with unfavorable outcomes.
- Successful rMT in patients with END correlated with favorable outcomes.
- Atrial fibrillation was identified as a predictor of END.
Conclusions:
- Patients with minor stroke, M2 occlusion, and atrial fibrillation require close monitoring for END during BMM.
- Prompt consideration for rMT is recommended for these patients if worsening occurs.
