Time Course and Clinical Relevance of Neurological Deterioration After Endovascular Recanalization Therapy for Anterior Circulation Large Vessel Occlusion Stroke

被引：13

作者：

Li, Zibao ^{[1
]}

Zhang, Hongchuan ^{[2
]}

Han, Jian ^{[3
]}

Chu, Zhaohu ^{[1
]}

Zhao, Shoucai ^{[1
]}

Yang, Qian ^{[1
]}

Huang, Xianjun ^{[1
]}

Zhou, Zhiming ^{[1
]}

机构：

[1] Yijishan Hosp, Dept Neurol, Wannan Med Coll, Wuhu, Peoples R China

[2] Yijishan Hosp, Dept Radiol, Wannan Med Coll, Wuhu, Peoples R China

[3] Huangshan City Peoples Hosp, Dept Neurol, Huangshan, Peoples R China

来源：

FRONTIERS IN AGING NEUROSCIENCE | 2021年 / 13卷

关键词：

neurological deterioration; time course; stroke; recanalization; odds ratio; ACUTE ISCHEMIC-STROKE; INTRAARTERIAL TREATMENT; BLOOD-PRESSURE; THROMBECTOMY; OUTCOMES; TRIAL; REVASCULARIZATION; ANGIOGRAPHY; COLLATERALS; SAFETY;

D O I：

10.3389/fnagi.2021.651614

中图分类号：

R592 [老年病学]; C [社会科学总论];

学科分类号：

03 ; 0303 ; 100203 ;

摘要：

Neurological deterioration (ND) is a devastating complication for patients with ischemic stroke after endovascular recanalization therapy (EVT). We aimed to investigate the time course and clinical relevance of ND after EVT. Consecutive patients with acute ischemic stroke who underwent EVT for large arterial occlusions of the anterior cerebral circulation were enrolled. The National Institutes of Health Stroke Scale (NIHSS) scores were assessed before EVT, at the end of EVT, at 24 h (d1), on day 3 (d3), on day 15 (d15), at discharge and anytime when ND was indicated. ND was defined as an increase of >= 4 points in the NIHSS score and was divided into acute ND (AD, within 24 h), subacute ND (SD, d1-d3), and delayed ND (DD, d3-d15 or discharge). Using multivariable logistic regression analysis, we explored predictors and outcomes of ND at different time periods. As a result, of 343 patients, 129 (37.6%) experienced ND, including 90 (26.2%) with AD, 27 (7.9%) with SD and 12 (3.5%) with DD. Multivariable logistic regression analysis revealed that history of hypertension, cardioembolic stroke, lower Alberta Stroke Program Early Computed Tomography Score (ASPECTS), and poor collaterals were significantly associated with an increased risk of AD; history of hypertension, lower ASPECTS, poor collaterals, and unsuccessful recanalization, with SD; and high admission NIHSS score, with DD. In addition, patients who experienced AD (OR = 10.22, P < 0.001), SD (OR = 15.89, P = 0.004), or DD (OR = 8.31, P = 0.015) were more likely to have poor outcomes. ND was a strong predictor of poor stroke outcomes. Management of related risk factors at different ND time periods might improve the prognosis of EVT.

引用

页数：7

共 31 条

[1]

Arenillas JF, 2018, J CEREBR BLOOD F MET, V38, P1839, DOI 10.1177/0271678X17740293

[2] Collateral Flow Predicts Response to Endovascular Therapy for Acute Ischemic Stroke [J].

Bang, Oh Young ;

Saver, Jeffrey L. ;

Kim, Suk Jae ;

Kim, Gyeong-Moon ;

Chung, Chin-Sang ;

Ovbiagele, Bruce ;

Lee, Kwang Ho ;

Liebeskind, David S. .

STROKE, 2011, 42 (03) :693-699

[3] A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke [J].

Berkhemer, O. A. ;

Fransen, P. S. S. ;

Beumer, D. ;

van den Berg, L. A. ;

Lingsma, H. F. ;

Yoo, A. J. ;

Schonewille, W. J. ;

Vos, J. A. ;

Nederkoorn, P. J. ;

Wermer, M. J. H. ;

van Walderveen, M. A. A. ;

Staals, J. ;

Hofmeijer, J. ;

van Oostayen, J. A. ;

Nijeholt, G. J. Lycklama A. ;

Boiten, J. ;

Brouwer, P. A. ;

Emmer, B. J. ;

de Bruijn, S. F. ;

van Dijk, L. C. ;

Kappelle, L. J. ;

Lo, R. H. ;

Van Dijk, E. J. ;

de Vries, J. ;

de Kort, P. L. M. ;

van Rooij, W. J. J. ;

van den Berg, J. S. P. ;

van Hasselt, B. A. A. M. ;

Aerden, L. A. M. ;

Dallinga, R. J. ;

Visser, M. C. ;

Bot, J. C. J. ;

Vroomen, P. C. ;

Eshghi, O. ;

Schreuder, T. H. C. M. L. ;

Heijboer, R. J. J. ;

Keizer, K. ;

Tielbeek, A. V. ;

den Hertog, H. M. ;

Gerrits, D. G. ;

van den Berg-Vos, R. M. ;

Karas, G. B. ;

Steyerberg, E. W. ;

Flach, H. Z. ;

Marquering, H. A. ;

Sprengers, M. E. S. ;

Jenniskens, S. F. M. ;

Beenen, L. F. M. ;

van den Berg, R. ;

Koudstaal, P. J. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (01) :11-20

[4] Impact of stroke co-morbidities on cortical collateral flow following ischaemic stroke [J].

Biose, Ifechukwude J. ;

Dewar, Deborah ;

Macrae, I. Mhairi ;

McCabe, Christopher .

JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM, 2020, 40 (05) :978-990

[5] Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection [J].

Campbell, B. C. V. ;

Mitchell, P. J. ;

Kleinig, T. J. ;

Dewey, H. M. ;

Churilov, L. ;

Yassi, N. ;

Yan, B. ;

Dowling, R. J. ;

Parsons, M. W. ;

Oxley, T. J. ;

Wu, T. Y. ;

Brooks, M. ;

Simpson, M. A. ;

Miteff, F. ;

Levi, C. R. ;

Krause, M. ;

Harrington, T. J. ;

Faulder, K. C. ;

Steinfort, B. S. ;

Priglinger, M. ;

Ang, T. ;

Scroop, R. ;

Barber, P. A. ;

McGuinness, B. ;

Wijeratne, T. ;

Phan, T. G. ;

Chong, W. ;

Chandra, R. V. ;

Bladin, C. F. ;

Badve, M. ;

Rice, H. ;

de Villiers, L. ;

Ma, H. ;

Desmond, P. M. ;

Donnan, G. A. ;

Davis, S. M. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (11) :1009-1018

[6] Failure of collateral blood flow is associated with infarct growth in ischemic stroke [J].

Campbell, Bruce C. V. ;

Christensen, Soren ;

Tress, Brian M. ;

Churilov, Leonid ;

Desmond, Patricia M. ;

Parsons, Mark W. ;

Barber, P. Alan ;

Levi, Christopher R. ;

Bladin, Christopher ;

Donnan, Geoffrey A. ;

Davis, Stephen M. .

JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM, 2013, 33 (08) :1168-1172

[7] Exploring the relationship between ischemic core volume and clinical outcomes after thrombectomy or thrombolysis [J].

Chen, Chushuang ;

Parsons, Mark W. ;

Levi, Christopher R. ;

Spratt, Neil J. ;

Miteff, Ferdinand ;

Lin, Longting ;

Cheng, Xin ;

Lou, Min ;

Kleinig, Tim ;

Butcher, Kenneth ;

Dong, Qiang ;

Bivard, Andrew .

NEUROLOGY, 2019, 93 (03) :E283-E292

[8] Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke [J].

Goyal, M. ;

Demchuk, A. M. ;

Menon, B. K. ;

Eesa, M. ;

Rempel, J. L. ;

Thornton, J. ;

Roy, D. ;

Jovin, T. G. ;

Willinsky, R. A. ;

Sapkota, B. L. ;

Dowlatshahi, D. ;

Frei, D. F. ;

Kamal, N. R. ;

Montanera, W. J. ;

Poppe, A. Y. ;

Ryckborst, K. J. ;

Silver, F. L. ;

Shuaib, A. ;

Tampieri, D. ;

Williams, D. ;

Bang, O. Y. ;

Baxter, B. W. ;

Burns, P. A. ;

Choe, H. ;

Heo, J. -H. ;

Holmstedt, C. A. ;

Jankowitz, B. ;

Kelly, M. ;

Linares, G. ;

Mandzia, J. L. ;

Shankar, J. ;

Sohn, S. -I. ;

Swartz, R. H. ;

Barber, P. A. ;

Coutts, S. B. ;

Smith, E. E. ;

Morrish, W. F. ;

Weill, A. ;

Subramaniam, S. ;

Mitha, A. P. ;

Wong, J. H. ;

Lowerison, M. W. ;

Sajobi, T. T. ;

Hill, M. D. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (11) :1019-1030

[9] Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials [J].

Goyal, Mayank ;

Menon, Bijoy K. ;

van Zwam, Wim H. ;

Dippel, Diederik W. J. ;

Mitchell, Peter J. ;

Demchuk, Andrew M. ;

Davalos, Antoni ;

Majoie, Charles B. L. M. ;

van der Lugt, Aad ;

de Miquel, Maria A. ;

Donnan, Geoff Rey A. ;

Roos, Yvo B. W. E. M. ;

Bonafe, Alain ;

Jahan, Reza ;

Diener, Hans-Christoph ;

van den Berg, Lucie A. ;

Levy, Elad I. ;

Berkhemer, Olvert A. ;

Pereira, Vitor M. ;

Rempel, Jeremy ;

Millan, Monica ;

Davis, Stephen M. ;

Roy, Daniel ;

Thornton, John ;

San Roman, Luis ;

Ribo, Marc ;

Beumer, Debbie ;

Stouch, Bruce ;

Brown, Scott ;

Campbell, Bruce C. V. ;

van Oostenbrugge, Robert J. ;

Saver, Jeff Rey L. ;

Hill, Michael D. ;

Jovin, Tudor G. .

LANCET, 2016, 387 (10029) :1723-1731

[10] Admission systolic blood pressure and outcomes in large vessel occlusion strokes treated with endovascular treatment [J].

Goyal, Nitin ;

Tsivgoulis, Georgios ;

Iftikhar, Sulaiman ;

Khorchid, Yasser ;

Ishfaq, Muhammad Fawad ;

Doss, Vinodh T. ;

Zand, Ramin ;

Chang, Jason ;

Alsherbini, Khalid ;

Choudhri, Asim ;

Hoit, Daniel ;

Alexandrov, Andrei V. ;

Arthur, Adam S. ;

Elijovich, Lucas .

JOURNAL OF NEUROINTERVENTIONAL SURGERY, 2017, 9 (05) :451-+

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