Early Neurological Deterioration After Recanalization: A Retrospective Study of 1053 Endovascular Treatment Patients

Many acute ischemic stroke patients experience poor functional outcomes despite successful recanalization following endovascular treatment (EVT). We aimed to identify predictive factors for early neurological deterioration (END) following successful EVT in acute ischemic stroke patients and to evaluate the impact of END on clinical outcomes.

One thousand fifty-three patients who achieved successful recanalization (modified treatment in cerebral infarction 2b-3) were divided into two groups: without END (No-END, n = 942) and with END (n = 111). Baseline characteristics, pretreatment Alberta Stroke Program Early CT Score (ASPECTS), onset-to-puncture time, atrial fibrillation (AF), and parenchymal hematoma (PH) were analyzed. Binary regression analysis was performed to identify independent predictors of END. Favorable functional outcomes (modified Rankin scale 0-2) and mortality were assessed at 3 months.

The END group had a lower prevalence of AF (26% vs. 36%, P = 0.026), lower pre-EVT ASPECTS scores (median 8 vs. 9, P < 0.001), longer onset-to-puncture time (median 360 vs. 290 minutes, P = 0.002), and a higher incidence of PH (39% vs. 10%, P < 0.001) compared to the No-END group. Binary regression analysis identified lower pre-EVT ASPECTS (odds ratio [OR]=0.742, P = 0.001), absence of AF (OR=0.575, P = 0.024), and presence of PH (OR=5.373, P < 0.001) as independent predictors of END. At 3 months, the END group had lower favorable outcomes (6% vs. 56%, P < 0.001) and higher mortality (63% vs. 13%, P < 0.001).

Lower pre-EVT ASPECTS scores, absence of AF, and presence of PH are independent predictors of END following successful recanalization. END is associated with significantly worse clinical outcomes, including lower rates of favorable functional outcomes and higher mortality.