TY - JOUR
T1 - Early neurological deterioration in patients with minor stroke due to isolated M2 occlusion undergoing medical management: a retrospective multicenter study
AU - Broccolini, Aldobrando
AU - Brunetti, Valerio
AU - Valente, Iacopo
AU - Falcou, Anne
AU - Frisullo, Giovanni
AU - Pedicelli, Alessandro
AU - Scala, Irene
AU - Rizzo, Pier Andrea
AU - Bellavia, Simone
AU - Camilli, Arianna
AU - Milonia, Luca
AU - Piano, Mariangela
AU - Macera, Antonio
AU - Commodaro, Christian
AU - Ruggiero, Maria
AU - Da Ros, Valerio
AU - Bellini, Luigi
AU - Lazzarotti, Guido A
AU - Cosottini, Mirco
AU - Caragliano, Armando A
AU - Vinci, Sergio L
AU - Gabrieli, Joseph D
AU - Causin, Francesco
AU - Panni, Pietro
AU - Roveri, Luisa
AU - Limbucci, Nicola
AU - Arba, Francesco
AU - Pileggi, Marco
AU - Bianco, Giovanni
AU - Romano, Daniele G
AU - Frauenfelder, Giulia
AU - Semeraro, Vittorio
AU - Ganimede, Maria P
AU - Lozupone, Emilio
AU - Fasano, Antonio
AU - Lafe, Elvis
AU - Cavallini, Anna
AU - Russo, Riccardo
AU - Bergui, Mauro
AU - Calabresi, Paolo
AU - Della Marca, Giacomo
PY - 2023
Y1 - 2023
N2 - Background: Patients with minor stroke and M2 occlusion undergoing best medical management (BMM) may face early neurological deterioration (END) that can lead to poor long-term outcome. In case of END, rescue mechanical thrombectomy (rMT) seems beneficial. Our study aimed to define factors relevant to clinical outcome in patients undergoing BMM with the possibility of rMT on END, and find predictors of END.
Methods: Patients with M2 occlusion and a baseline National Institutes of Health Stroke Scale (NIHSS) score≤5 that received either BMM only or rMT on END after BMM were extracted from the databases of 16 comprehensive stroke centers. Clinical outcome measures were a 90-day modified Rankin Scale (mRS) score of 0-1 or 0-2, and occurrence of END.
Results: Among 10 169 consecutive patients with large vessel occlusion admitted between 2016 and 2021, 208 patients were available for analysis. END was reported in 87 patients that were therefore all subjected to rMT. In a logistic regression model, END (OR 3.386, 95% CI 1.428 to 8.032), baseline NIHSS score (OR 1.362, 95% CI 1.004 to 1.848) and a pre-event mRS score=1 (OR 3.226, 95% CI 1.229 to 8.465) were associated with unfavorable outcome. In patients with END, successful rMT was associated with favorable outcome (OR 4.549, 95% CI 1.098 to 18.851). Among baseline clinical and neuroradiological features, presence of atrial fibrillation was a predictor of END (OR 3.547, 95% CI 1.014 to 12.406).
Conclusion: Patients with minor stroke due to M2 occlusion and atrial fibrillation should be closely monitored for possible worsening during BMM and, in this case, promptly considered for rMT.
AB - Background: Patients with minor stroke and M2 occlusion undergoing best medical management (BMM) may face early neurological deterioration (END) that can lead to poor long-term outcome. In case of END, rescue mechanical thrombectomy (rMT) seems beneficial. Our study aimed to define factors relevant to clinical outcome in patients undergoing BMM with the possibility of rMT on END, and find predictors of END.
Methods: Patients with M2 occlusion and a baseline National Institutes of Health Stroke Scale (NIHSS) score≤5 that received either BMM only or rMT on END after BMM were extracted from the databases of 16 comprehensive stroke centers. Clinical outcome measures were a 90-day modified Rankin Scale (mRS) score of 0-1 or 0-2, and occurrence of END.
Results: Among 10 169 consecutive patients with large vessel occlusion admitted between 2016 and 2021, 208 patients were available for analysis. END was reported in 87 patients that were therefore all subjected to rMT. In a logistic regression model, END (OR 3.386, 95% CI 1.428 to 8.032), baseline NIHSS score (OR 1.362, 95% CI 1.004 to 1.848) and a pre-event mRS score=1 (OR 3.226, 95% CI 1.229 to 8.465) were associated with unfavorable outcome. In patients with END, successful rMT was associated with favorable outcome (OR 4.549, 95% CI 1.098 to 18.851). Among baseline clinical and neuroradiological features, presence of atrial fibrillation was a predictor of END (OR 3.547, 95% CI 1.014 to 12.406).
Conclusion: Patients with minor stroke due to M2 occlusion and atrial fibrillation should be closely monitored for possible worsening during BMM and, in this case, promptly considered for rMT.
KW - Stroke
KW - Stroke
UR - http://hdl.handle.net/10807/232527
U2 - 10.1136/jnis-2023-020118
DO - 10.1136/jnis-2023-020118
M3 - Article
SN - 1759-8478
VL - 16
SP - 38
EP - 44
JO - Journal of NeuroInterventional Surgery
JF - Journal of NeuroInterventional Surgery
ER -