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Predictors of Unexplained Early Neurological Deterioration After Endovascular Treatment for Acute Ischemic Stroke

Jean-Baptiste Girot 1, 2 Sébastien Richard 3, 4 Florent Gariel 5 Igor Sibon 6 Julien Labreuche 7 Maéva Kyheng 7 Benjamin Gory 8, 9 Cyril Dargazanli 10 Benjamin Maier 11 Arturo Consoli 12, 8 Benjamin Daumas-Duport 2 Bertrand Lapergue 12 Romain Bourcier 2 Michel Piotin Raphael Blanc Hocine Redjem Simon Escalard Jean-Philippe Desilles Gabriele Ciccio Stanislas Smajda Mikael Mazighi Mikael Obadia Candice Sabben Roxanne Peres Ovide Corabianu Thomas de Broucker Didier Smadja Sonia Alamowitch Olivier Ille Eric Manchon Pierre-Yves Garcia Guillaume Taylor Malek Ben Maacha Adrien Wang Serge Evrard Maya Tchikviladze Nadia Ajili David Weisenburger Lucas Gorza Géraldine Buard Oguzhan Coskun Federico Di Maria Georges Rodesh Sergio Zimatore Morgan Leguen Julie Gratieux Fernando Pico Haja Rakotoharinandrasana Philippe Tassan Roxanna Poll Sylvie Marinier Norbert Nighoghossian Roberto Riva Omer Eker Francis Turjman Laurent Derex Tae-Hee Cho Laura Mechtouff Anne Claire Lukaszewicz Frédéric Philippeau Serkan Cakmak Karine Blanc-Lasserre Anne-Evelyne Vallet Gaultier Marnat Xavier Barreau Jérôme Berge Louis Veunac Patrice Menegon Ludovic Lucas Stéphane Olindo Pauline Renou Sharmila Sagnier Mathilde Poli Sabrina Debruxelles Thomas Tourdias Et Jean-Sebastien Liegey Lili Detraz Pierre-Louis Alexandre Monica Roy Cédric Lenoble Vincent L’allinec Hubert Desal Benoît Guillon Solène de Gaalon Cécile Preterre Serge Bracard 8 René Anxionnat 8 Marc Braun 8 Anne-Laure Derelle Romain Tonnelet Liang Liao François Zhu 8 Emmanuelle Schmitt Sophie Planel Lisa Humbertjean Gioia Mione Jean-Christophe Lacour Mathieu Bonnerot Nolwenn Riou-Comte Francisco Macian-Montoro Suzanna Saleme Charbel Mounayer Aymeric Rouchaud Vincent Costalat 13, 14 Caroline Arquizan Grégory Gascou Pierre-Henri Lefèvre Imad Derraz Carlos Riquelme Nicolas Gaillard Isabelle Mourand Lucas Corti Eugene Francois Stéphane Vannier Jean-Christophe Ferre Helene Raoult Thomas Ronziere Maria Lassale Christophe Paya Jean-Yves Gauvrit Clément Tracol Sophie Langnier-Lemercier Yves Samson Charlotte Rosso Anne Leger Sandrine Deltour Frederic Clarencon Eimad Shotar Laurent Spelle Christian Denier Vanessa Chalumeau Jildaz Caroff Olivier Chassin Laura Venditti Guillaume Turc Glivier Naggara Gregoire Boulouis Waghih Ben Hassen Pierre Seners Alain Viguier Christophe Cognard Anne Christine Januel Jean-Marc Olivot Nicolas Raposo Fabrice Bonneville Emmanuel Touze Charlotte Barbier Romain Schneckenburger Marion Boulanger Julien Cogez Sophie Guettier
Abstract : Background and Purpose: Although the efficacy of endovascular treatment (EVT) in patients with anterior circulation ischemic stroke (AIS) is well documented, early neurological deterioration after EVT remains a serious issue associated with poor outcome. Besides obvious causes, such as lack of reperfusion, procedural complications, or parenchymal hemorrhage, early neurological deterioration may remain unexplained (UnEND). Our aim was to investigate predictors of UnEND after EVT in patients with AIS. Methods: Patients who underwent EVT for AIS, with an initial National Institutes of Health Stroke Scale score >5, Alberta Stroke Program Early CT Score ≥6, and included in a multicenter prospective observational registry were analyzed. Predictors of UnEND, defined as ≥4-point increase in the National Institutes of Health Stroke Scale score between baseline and day 1 after EVT, were determined via center-adjusted analyses. Results: Among the 1925 included in the analysis, 128 UnEND (6.6%) were recorded. In multivariate analysis, predictors of UnEND were diabetes mellitus (odds ratio [OR], 2.17 [95% CI, 1.32–3.56]), prestroke modified Rankin Scale score ≥2 (OR, 2.22 [95% CI, 1.09–4.55]), general anesthesia (OR, 2.55 [95% CI, 1.51–4.30]), admission systolic blood pressure (OR, 1.10 [95% CI, 1.01–1.20]), age (OR, 1.38 [95% CI, 1.14–1.67]), number of passes (OR, 1.16 [95% CI, 1.04–1.28]), direct admission or not to a comprehensive stroke center (OR, 0.49 [95% CI, 0.30–0.81]), and initial National Institutes of Health Stroke Scale score (OR, 0.65 [95% CI, 0.52–0.81]). Conclusions: Severely impaired AIS patients with nonmodifiable factors are more likely to develop UnEND. Some modifiable predictors of UnEND such as the number of EVT passes could be the object of improvement in AIS management.
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https://hal.univ-lorraine.fr/hal-03280043
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Submitted on : Wednesday, July 7, 2021 - 8:24:35 AM
Last modification on : Wednesday, September 22, 2021 - 3:32:23 AM

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Jean-Baptiste Girot, Sébastien Richard, Florent Gariel, Igor Sibon, Julien Labreuche, et al.. Predictors of Unexplained Early Neurological Deterioration After Endovascular Treatment for Acute Ischemic Stroke. Stroke, American Heart Association, 2020, 51 (10), pp.2943-2950. ⟨10.1161/STROKEAHA.120.029494⟩. ⟨hal-03280043⟩

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