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Journal Articles Stroke Year : 2020

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 Ferré , 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
Igor Sibon
Michel Piotin
Raphael Blanc
Hocine Redjem
Simon Escalard
Jean-Philippe Desilles
  • Function : Author
Gabriele Ciccio
Stanislas Smajda
  • Function : Author
Mikael Mazighi
Mikael Obadia
  • Function : Author
Candice Sabben
  • Function : Author
Roxanne Peres
  • Function : Author
Ovide Corabianu
  • Function : Author
Thomas de Broucker
  • Function : Author
Didier Smadja
  • Function : Author
Sonia Alamowitch
  • Function : Author
Olivier Ille
  • Function : Author
Eric Manchon
  • Function : Author
Pierre-Yves Garcia
  • Function : Author
Guillaume Taylor
  • Function : Author
Malek Ben Maacha
  • Function : Author
Adrien Wang
  • Function : Author
Serge Evrard
  • Function : Author
Maya Tchikviladze
  • Function : Author
Nadia Ajili
  • Function : Author
David Weisenburger
  • Function : Author
Lucas Gorza
  • Function : Author
Géraldine Buard
  • Function : Author
Oguzhan Coskun
  • Function : Author
Federico Di Maria
  • Function : Author
Georges Rodesh
  • Function : Author
Sergio Zimatore
  • Function : Author
Morgan Leguen
  • Function : Author
Julie Gratieux
  • Function : Author
Fernando Pico
  • Function : Author
Haja Rakotoharinandrasana
  • Function : Author
Philippe Tassan
  • Function : Author
Roxanna Poll
  • Function : Author
Sylvie Marinier
  • Function : Author
Norbert Nighoghossian
  • Function : Author
Roberto Riva
  • Function : Author
Omer Eker
  • Function : Author
Francis Turjman
  • Function : Author
Laurent Derex
  • Function : Author
Tae-Hee Cho
  • Function : Author
Laura Mechtouff
Anne Claire Lukaszewicz
  • Function : Author
Frédéric Philippeau
  • Function : Author
Serkan Cakmak
  • Function : Author
Karine Blanc-Lasserre
  • Function : Author
Anne-Evelyne Vallet
  • Function : Author
Gaultier Marnat
Xavier Barreau
  • Function : Author
Jérôme Berge
  • Function : Author
Louis Veunac
  • Function : Author
Patrice Menegon
  • Function : Author
Ludovic Lucas
  • Function : Author
Stéphane Olindo
  • Function : Author
Pauline Renou
  • Function : Author
Sharmila Sagnier
Mathilde Poli
  • Function : Author
Sabrina Debruxelles
  • Function : Author
Lili Detraz
  • Function : Author
Pierre-Louis Alexandre
  • Function : Author
Monica Roy
  • Function : Author
Cédric Lenoble
  • Function : Author
Vincent L’allinec
  • Function : Author
Hubert Desal
Benoît Guillon
  • Function : Author
Solène de Gaalon
  • Function : Author
Cécile Preterre
  • Function : Author
Anne-Laure Derelle
  • Function : Author
Romain Tonnelet
  • Function : Author
Liang Liao
  • Function : Author
Emmanuelle Schmitt
Sophie Planel
  • Function : Author
Lisa Humbertjean
  • Function : Author
Gioia Mione
  • Function : Author
Jean-Christophe Lacour
  • Function : Author
Mathieu Bonnerot
  • Function : Author
Nolwenn Riou-Comte
  • Function : Author
Francisco Macian-Montoro
  • Function : Author
Suzanna Saleme
  • Function : Author
Charbel Mounayer
  • Function : Author
Aymeric Rouchaud
  • Function : Author
Caroline Arquizan
  • Function : Author
Grégory Gascou
  • Function : Author
Pierre-Henri Lefèvre
  • Function : Author
Imad Derraz
Carlos Riquelme
Nicolas Gaillard
Isabelle Mourand
Lucas Corti
  • Function : Author
Eugene Francois
  • Function : Author
Stéphane Vannier
  • Function : Author
Jean-Christophe Ferré
Helene Raoult
  • Function : Author
Thomas Ronziere
  • Function : Author
Maria Lassale
  • Function : Author
Christophe Paya
  • Function : Author
Jean-Yves Gauvrit
  • Function : Author
Clément Tracol
  • Function : Author
Sophie Langnier-Lemercier
  • Function : Author
Yves Samson
  • Function : Author
Charlotte Rosso
  • Function : Author
Anne Leger
  • Function : Author
Sandrine Deltour
  • Function : Author
Frederic Clarencon
  • Function : Author
Eimad Shotar
Laurent Spelle
Christian Denier
Vanessa Chalumeau
  • Function : Author
Jildaz Caroff
Olivier Chassin
  • Function : Author
Laura Venditti
  • Function : Author
Guillaume Turc
Glivier Naggara
  • Function : Author
Gregoire Boulouis
Waghih Ben Hassen
  • Function : Author
Pierre Seners
Alain Viguier
  • Function : Author
Christophe Cognard
  • Function : Author
Anne Christine Januel
  • Function : Author
Jean-Marc Olivot
  • Function : Author
Nicolas Raposo
  • Function : Author
Fabrice Bonneville
Emmanuel Touze
  • Function : Author
Charlotte Barbier
  • Function : Author
Romain Schneckenburger
  • Function : Author
Marion Boulanger
  • Function : Author
Julien Cogez
  • Function : Author
Sophie Guettier
  • Function : Author

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.

Dates and versions

hal-03280043 , version 1 (07-07-2021)

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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, 2020, 51 (10), pp.2943-2950. ⟨10.1161/STROKEAHA.120.029494⟩. ⟨hal-03280043⟩
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