Incidence and mechanism of early neurological deterioration after endovascular thrombectomy

被引：98

作者：

Kim, Jeong-Min ^{[1
]}

Bae, Jae-Han ^{[1
]}

Park, Kwang-Yeol ^{[1
]}

Lee, Woong Jae ^{[2
]}

Byun, Jun Soo ^{[2
]}

Ahn, Suk-Won ^{[1
]}

Shin, Hae-Won ^{[1
]}

Han, Su-Hyun ^{[1
]}

Yoo, Il-Han ^{[1
]}

机构：

[1] Chung Ang Univ, Coll Med, Chung Ang Univ Hosp, Dept Neurol, 224-1 Heukseok Dong, Seoul 156755, South Korea

[2] Chung Ang Univ, Coll Med, Chung Ang Univ Hosp, Dept Neuroradiol, Seoul, South Korea

来源：

JOURNAL OF NEUROLOGY | 2019年 / 266卷 / 03期

基金：

新加坡国家研究基金会;

关键词：

Stroke; Mechanical thrombectomy; Prognosis; ACUTE ISCHEMIC-STROKE; THROMBOLYSIS; CARE;

D O I：

10.1007/s00415-018-09173-0

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

BackgroundWe investigated the prevalence and mechanisms of neurological deterioration after endovascular thrombectomy.MethodsBetween 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.ResultsA 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 72h. 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 3-6at 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.ConclusionNeurological deterioration frequently occurs after endovascular thrombectomy, and the risk factors of END differ according to the mechanism of END.

引用

页码：609 / 615

页数：7

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