Unexplained early neurological deterioration after endovascular treatment for acute large vessel occlusion: incidence, predictors, and clinical impact: Data from ANGEL-ACT registry

Dapeng Sun; Xu Tong; Xiaochuan Huo; Baixue Jia; Raynald; Anxin Wang; Gaoting Ma; Ning Ma; Feng Gao; Dapeng Mo; Ligang Song; Xuan Sun; Lian Liu; Yiming Deng; Xiaoqing Li; Bo Wang; Gang Luo; Yongjun Wang; Zhongrong Miao; ANGEL-ACT study group

doi:10.1136/neurintsurg-2021-017956

Unexplained early neurological deterioration after endovascular treatment for acute large vessel occlusion: incidence, predictors, and clinical impact: Data from ANGEL-ACT registry

J Neurointerv Surg. 2022 Sep;14(9):875-880. doi: 10.1136/neurintsurg-2021-017956. Epub 2021 Sep 30.

Authors

Dapeng Sun¹, Xu Tong¹, Xiaochuan Huo¹, Baixue Jia¹, Raynald¹, Anxin Wang², Gaoting Ma¹, Ning Ma¹, Feng Gao¹, Dapeng Mo¹, Ligang Song¹, Xuan Sun¹, Lian Liu¹, Yiming Deng¹, Xiaoqing Li¹, Bo Wang¹, Gang Luo¹, Yongjun Wang², Zhongrong Miao³; ANGEL-ACT study group

Affiliations

¹ Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
² China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
³ Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China zhongrongm@163.com.

PMID: 34593600
DOI: 10.1136/neurintsurg-2021-017956

Abstract

Background: Early neurological deterioration (END) may occur in some patients with acute large vessel occlusion (LVO) undergoing endovascular treatment (EVT). Despite several clear causes of END, such as symptomatic intracranial hemorrhage, failure of recanalization, and intraprocedure complications, a particular END, termed unexplained END (END_unexplained), exists. We aimed to investigate the incidence, independent predictors, and clinical impact of END_unexplained after EVT in patients with acute LVO.

Methods: Subjects were selected from the ANGEL-ACT registry. END_unexplained was defined as ≥4-point increase in the National Institutes of Health Stroke Scale (NIHSS) score between baseline and 24 hours after EVT, without the causes listed above. Logistic regression analyses were performed to determine the independent predictors of END_unexplained, as well as the association between END_unexplained and 90-day outcomes assessed by modified Rankin Scale (mRS) score.

Results: Among the 1557 enrolled patients, the incidence of END_unexplained was 4.3% (67/1557). Admission NIHSS ≤8 (OR=6.88, 95% CI 3.86 to 12.26, p<0.001), general anesthesia (OR=3.15, 95% CI 1.81 to 5.48, p<0.001), admission neutrophil to lymphocyte ratio >5 (OR=2.82, 95% CI 1.61 to 4.94, p<0.001), and number of EVT attempts >3 (OR=2.11, 95% CI 1.14 to 3.89, p=0.018) were associated independently with a high risk of END_unexplained. Furthermore, patients with END_unexplained were associated with a shift toward worse 90-day outcomes (mRS 5 vs 3, common OR=5.24, 95% CI 3.22 to 8.52, p<0.001).

Conclusions: END_unexplained associated with poor 90day outcomes occurred in 4.3% of patients with acute LVO undergoing EVT. Several independent predictors of END_unexplained were identified in this study, which should be considered in daily practice to improve acute LVO management.

Clinical trial registration: http://wwwclinicaltrialsgov NCT03370939.

Keywords: stroke; thrombectomy.

MeSH terms

Brain Ischemia* / epidemiology
Brain Ischemia* / surgery
Endovascular Procedures* / adverse effects
Endovascular Procedures* / methods
Humans
Incidence
Registries
Stroke* / therapy
Thrombectomy / methods
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT03370939