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01-03-2019 | Stroke | Original Communication

Incidence and mechanism of early neurological deterioration after endovascular thrombectomy

Authors: Jeong-Min Kim, Jae-Han Bae, Kwang-Yeol Park, Woong Jae Lee, Jun Soo Byun, Suk-Won Ahn, Hae-Won Shin, Su-Hyun Han, Il-Han Yoo

Published in: Journal of Neurology | Issue 3/2019

Abstract

Background

We investigated the prevalence and mechanisms of neurological deterioration after endovascular thrombectomy.

Methods

Between January 2011 and October 2017, acute ischemic stroke patients treated by endovascular thrombectomy in a tertiary university hospital were included. Early neurological deterioration (END) was defined as an increase of 2 or more National Institute of Health Stroke Scale (NIHSS) compared to the best neurological status after stroke within 7 days. The END mechanism was categorized into ischemia progression, symptomatic hemorrhage, and brain edema.

Results

A total of 125 acute ischemic stroke patients received endovascular thrombectomy. Neurological deterioration was detected in 44 patients, and 38 cases (86.4% of END) occurred within 72 h. The END mechanism included 20 ischemia progression, 16 brain edema and 8 hemorrhagic transformation cases. Multivariable logistic regression analysis revealed that the patients who experienced END were more likely to have poor functional outcome defined as modified Rankin scale 3–6 at 90 days than neurologically stable patients (odds ratio (OR) = 4.06, confidence interval (CI) = 1.39–11.9). The risk factor of END due to ischemia progression was stroke subtype of large artery atherosclerosis (OR = 6.28, CI = 1.79–22.0). Successful recanalization (OR = 0.11, CI = 0.03–0.39) and NIHSS after endovascular thrombectomy (OR = 1.15 per one-point increase, CI = 1.06–1.24) were significantly associated with END due to hemorrhage or brain edema.

Conclusion

Neurological deterioration frequently occurs after endovascular thrombectomy, and the risk factors of END differ according to the mechanism of END.

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Title: Incidence and mechanism of early neurological deterioration after endovascular thrombectomy
Authors: Jeong-Min Kim
Jae-Han Bae
Kwang-Yeol Park
Woong Jae Lee
Jun Soo Byun
Suk-Won Ahn
Hae-Won Shin
Su-Hyun Han
Il-Han Yoo
Publication date: 01-03-2019
Publisher: Springer Berlin Heidelberg
Keywords: Stroke
Edema
Arterial Occlusive Disease
Thrombectomy
Published in: Journal of Neurology / Issue 3/2019
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-018-09173-0

At a glance: The STEP trials

Springer Medicine

Incidence and mechanism of early neurological deterioration after endovascular thrombectomy

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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