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Preoperative Neurological Changes on Outcomes in Large-Vessel Occlusion Due to Intracranial Atherosclerotic Disease
Takeshi Yoshimoto1,2, Kanta Tanaka3,4, Junpei Koge4,5
1Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Japan.
Insights
Neurological deterioration before endovascular therapy (EVT) in intracranial atherosclerotic disease with large-vessel occlusion (ICAD-LVO) is linked to poorer outcomes. Early detection and intervention are crucial for improving results in these stroke patients.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Neurology
Background:
- Intracranial atherosclerotic disease with large-vessel occlusion (ICAD-LVO) is a significant cause of ischemic stroke.
- Endovascular therapy (EVT) is a critical treatment for acute ischemic stroke caused by LVO.
- Predicting outcomes in ICAD-LVO patients undergoing EVT remains a challenge.
Purpose of the Study:
- To investigate the association between neurological deterioration prior to EVT and patient outcomes.
- To analyze outcomes in ICAD-LVO patients stratified by neurological severity changes.
- To identify factors influencing treatment success in EVT for ICAD-LVO.
Main Methods:
- A Japanese multicenter registry study included 480 patients with acute ICAD-LVO undergoing EVT (2017-2019).
- Patients were categorized based on National Institutes of Health Stroke Scale (NIHSS) score changes: mild symptoms, symptom deterioration, and severe symptoms.
- Outcomes assessed included favorable modified Rankin Scale (mRS) scores at 90 days, ordinal mRS shift, and symptomatic intracranial hemorrhage, analyzed using multivariable logistic regression.
Main Results:
- Patients experiencing symptom deterioration (38.2%) and severe symptoms (35.3%) had significantly lower favorable outcomes compared to those with mild symptoms (62.9%).
- Neurological deterioration pre-EVT was associated with poorer functional outcomes (adjusted odds ratio 0.30 for deterioration, 0.47 for severe symptoms).
- Symptomatic intracranial hemorrhage rates were similar across groups (0% for mild and deterioration, 1.9% for severe symptoms).
Conclusions:
- Worsening neurological symptoms before EVT in ICAD-LVO patients correlate with reduced chances of a favorable outcome.
- Prompt identification of neurological deterioration and timely EVT intervention are essential for improving patient outcomes.
- This study highlights the importance of monitoring neurological status during acute stroke management for ICAD-LVO.
Background And Objectives:
We aimed to clarify the association between neurological deterioration pre-endovascular therapy (EVT) and outcome in patients with large-vessel occlusion due to intracranial atherosclerotic disease (ICAD-LVO) undergoing EVT.
Methods:
Consecutive patients with acute ischemic stroke due to ICAD-LVO within 24 h of onset who underwent EVT were enrolled in the Japanese multicenter registry from 2017 to 2019. Patients were grouped according to neurological severity transition as follows: mild symptoms (baseline National Institutes of Health Stroke Scale [NIHSS] score <6 and NIHSS score pre-EVT <6), symptom deterioration (baseline NIHSS score <6 and NIHSS score pre-EVT ≥6), and severe symptoms (baseline NIHSS score ≥6 and NIHSS score pre-EVT ≥6). Outcomes included favorable outcomes (modified Rankin Scale [mRS] score of 0-2 at 90 days), ordinal mRS shift, and symptomatic intracranial hemorrhage. Multivariable logistic regression assessed the association of outcomes with the transition of neurological severity by calculating odds ratios and 95% CIs, with mild symptoms as reference.
Results:
In total, 480 patients with acute ICAD-LVO who underwent EVT (150 women [31.2%]; median age, 72 years IQR, 66-80) and had median baseline NIHSS score 12 (IQR, 6-20) were analyzed. Patients with symptom deterioration (n = 34) and severe symptoms (n = 375) had lower favorable outcomes (deterioration 38.2% vs mild 62.9%; adjusted odds ratio 0.30, 95% CI 0.09-0.97, severe 35.3%; 0.47, 0.33-0.65) and a significant mRS shift (deterioration vs mild; 3.63, 1.46-9.03, severe; 2.27, 1.74-2.96) than those with mild symptoms (n = 71). Symptomatic intracranial hemorrhage rates did not differ (mild 0%; deterioration 0%; severe 1.9%).
Conclusion:
Patients with ICAD-LVO who experienced worsening symptoms were less likely to achieve favorable outcomes after EVT than those with mild symptoms. Early identification of neurological deterioration and EVT intervention may improve outcomes in these patients.
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