Motor evoked potentials during revascularization in ischemic stroke predict motor pathway ischemia and clinical outcome
| Autor: | Bernhard Meyer, Tobias Greve, Sebastian Ille, Kornelia Kreiser, Claus Zimmer, Ehab Shiban, Benno Ikenberg, Arthur Wagner, Silke Wunderlich |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Ischemia Revascularization 050105 experimental psychology 03 medical and health sciences 0302 clinical medicine Modified Rankin Scale Physiology (medical) Internal medicine medicine Humans 0501 psychology and cognitive sciences Evoked potential Aged Ischemic Stroke Aged 80 and over Abductor pollicis brevis muscle Cerebral Revascularization medicine.diagnostic_test Cerebral infarction business.industry 05 social sciences Magnetic resonance imaging Recovery of Function Thrombolysis Middle Aged Evoked Potentials Motor Prognosis medicine.disease Sensory Systems Treatment Outcome Neurology Cardiology Female Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | Clinical Neurophysiology. 131:2307-2314 |
| ISSN: | 1388-2457 |
| Popis: | Objective The relevance of motor evoked potential (MEP) recovery during mechanical endovascular thrombectomy (MT) in patients with ischemic stroke is unclear. We correlated MEP recovery during MT to symptom improvement and to ischemia in eloquent motor areas on magnetic resonance imaging (MRI) and compared the predictive value of MEPs to visual angiographic reperfusion status, classified by modified Thrombolysis in Cerebral Infarction grading (mTICI). Methods Patients with hemisyndrome and large-vessel occlusion undergoing MT were included (n35, 49% females; 73.9 ± 14.5 years; n31 anterior circulation). MEPs were elicited transcranially and recorded at the abductor pollicis brevis muscle bilaterally throughout the procedure. An MRI was acquired within 7 days after MT. Results The median door-to-needle time was 3.5 hours. Median National Institutes of Health Stroke Scale at presentation was 16 (7 – 37). Median Modified Rankin Scale score was 4 at day 7 and 3 months. After MT, MEP-recovery occurred in 21 cases after a median time span of 4.5 min [range 2 – 11 min]. Symptom improvement at day 7 (3 months) was noted in 22 (21) cases. Absence of ischemia on postinterventional MRI was noted in 21 cases, 19 of whom showed MEP-recovery. Stratified for symptom improvement at day 7, sensitivity (specificity) of MEP-recovery was 86% (85%) and of mTICI ≥ 2b was 95% (23%). Stratified for absence of ischemia on postinterventional MRI, sensitivity (specificity) of MEP-recovery was 90% (86%) and of mTICI ≥ 2b was of 95% (21%). Conclusions MEP recovery occurs early after successful endovascular mechanical revascularization and is superior to mTICI grading in predicting postoperative neurological outcome and postoperative motor-pathway ischemia. Significance This is a new, significant and clinically important study since it emphasizes the additional value of MEP monitoring in a field, which has been traditionally unaffiliated with neurophysiological monitoring. |
| Databáze: | OpenAIRE |
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