Delayed Neurological Improvement After Full Endovascular Reperfusion in Acute Anterior Circulation Ischemic Stroke
| Autor: | Agustín Mayo-Iscar, Mar Castellanos, Juan Manuel García-Sánchez, María Pilar Navarro-Pérez, Javier Tejada-García, Yolanda Bravo-Anguiano, Maite Martínez-Zabaleta, Mario Martínez-Galdámez, Luis López-Mesonero, Yésica Jiménez-López, Juan F. Arenillas, Gabriela Rodrigo-Stevens, Herbert Tejada-Meza, Mónica Bártulos-Iglesias, Alexia Roel, Javier Marta-Moreno, Maria Del Mar Freijo, Alain Luna, Carmen García-Cabo, Cristina Pérez-Lázaro, María Del Carmen Gil-Alzueta, Nordictus investigators, Beatriz Gómez-Vicente, Patricia de la Riva, Juan José Timiraos-Fernández, Laura Redondo-Robles, Blanca Talavera, Elena López-Cancio, Enrique Jesús Palacio-Portilla |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Advanced and Specialized Nursing
Aged 80 and over Male medicine.medical_specialty Cerebral Revascularization business.industry Endovascular Procedures Middle Aged Brain Ischemia Internal medicine Ischemic stroke Cardiology Medicine Humans Female Neurology (clinical) Prospective Studies Registries Nervous System Diseases Cardiology and Cardiovascular Medicine business Aged Follow-Up Studies Ischemic Stroke Retrospective Studies |
| Zdroj: | Stroke. 52(7) |
| ISSN: | 1524-4628 |
| Popis: | Background and Purpose: We aimed to determine the prevalence and predictors of delayed neurological improvement (DNI) after complete endovascular reperfusion in anterior circulation acute ischemic stroke (AIS). Methods: Retrospective analysis of an online multicenter prospective reperfusion registry of patients with consecutive anterior circulation AIS treated with endovascular thrombectomy (EVT) from January 2018 to June 2019 in tertiary stroke centers of the NORDICTUS (NORD-Spain Network for Research and Innovation in ICTUS) network. We included patients with AIS with a proximal occlusion in whom a modified Thrombolysis in Cerebral Infarction 3 reperfusion pattern was obtained. DNI was defined if, despite absence of early neurological improvement during the first 24 hours, patients achieved functional independence on day 90. Clinical and radiological variables obtained before EVT were analyzed as potential predictors of DNI. Results: Of 1565 patients with consecutive AIS treated with EVT, 1381 had proximal anterior circulation occlusions, 803 (58%) of whom achieved a modified Thrombolysis in Cerebral Infarction 3. Of these, 628 patients fulfilled all selection criteria and were included in the study. Mean age was 73.8 years, 323 (51.4%) were female, and median baseline National Institutes of Health Stroke Scale was 16. Absence of early neurological improvement was observed in 142 (22.6%) patients; 32 of these (22.5%) achieved good long-term outcome and constitute the DNI group. Predictors of DNI in multivariable-adjusted logistic regression were male sex (odds ratio, 6.4 [95% CI, 2.1–22.3] P =0.002), lower pre-EVT National Institutes of Health Stroke Scale score (odds ratio, 1.4 [95% CI, 1.2–1.5], P P Conclusions: One-quarter of patients with anterior circulation AIS who do not clinically improve within the first 24 hours after complete cerebral endovascular recanalization will achieve long-term functional independence, regardless of the poor early clinical course. Male sex, lower initial clinical severity, and use of intravenous thrombolysis before EVT predicted this clinical pattern. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|