Predictors of Unexplained Early Neurological ...
Document type :
Article dans une revue scientifique: Article original
PMID :
Permalink :
Title :
Predictors of Unexplained Early Neurological Deterioration After Endovascular Treatment for Acute Ischemic Stroke.
Author(s) :
Girot, Jean-Baptiste [Auteur]
Département de Neuro-Radiologie [Angers] [DNR - Angers]
Richard, Sébastien [Auteur]
Défaillance Cardiovasculaire Aiguë et Chronique [DCAC]
Gariel, Florent [Auteur]
Département de Neuro-Radiologie [Bordeaux] [DNR - Bordeaux]
Sibon, Igor [Auteur]
Service de neurologie [Bordeaux]
Labreuche, Julien [Auteur]
METRICS : Evaluation des technologies de santé et des pratiques médicales - ULR 2694
Kyheng, MaÉva [Auteur]
Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Gory, Benjamin [Auteur]
Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy]
Dargazanli, Cyril [Auteur]
Département de Neuroradiologie[Montpellier]
Maier, Benjamin [Auteur]
Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP]
Consoli, Arturo [Auteur]
Hôpital Foch [Suresnes]
Daumas-Duport, Benjamin [Auteur]
Centre Hospitalier Universitaire de Nantes = Nantes University Hospital [CHU Nantes]
Lapergue, Bertrand [Auteur]
Service de neuroradiologie [Suresnes]
Bourcier, Romain [Auteur]
Centre Hospitalier Universitaire de Nantes = Nantes University Hospital [CHU Nantes]
Département de Neuro-Radiologie [Angers] [DNR - Angers]
Richard, Sébastien [Auteur]
Défaillance Cardiovasculaire Aiguë et Chronique [DCAC]
Gariel, Florent [Auteur]
Département de Neuro-Radiologie [Bordeaux] [DNR - Bordeaux]
Sibon, Igor [Auteur]
Service de neurologie [Bordeaux]
Labreuche, Julien [Auteur]
METRICS : Evaluation des technologies de santé et des pratiques médicales - ULR 2694
Kyheng, MaÉva [Auteur]
Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Gory, Benjamin [Auteur]
Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy]
Dargazanli, Cyril [Auteur]
Département de Neuroradiologie[Montpellier]
Maier, Benjamin [Auteur]
Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP]
Consoli, Arturo [Auteur]
Hôpital Foch [Suresnes]
Daumas-Duport, Benjamin [Auteur]
Centre Hospitalier Universitaire de Nantes = Nantes University Hospital [CHU Nantes]
Lapergue, Bertrand [Auteur]
Service de neuroradiologie [Suresnes]
Bourcier, Romain [Auteur]
Centre Hospitalier Universitaire de Nantes = Nantes University Hospital [CHU Nantes]
Journal title :
Stroke
Abbreviated title :
Stroke
Volume number :
51
Pages :
2943–2950
Publication date :
2020-09-19
ISSN :
1524-4628
English keyword(s) :
blood pressure
brain ischemia
registries
reperfusion
stroke
brain ischemia
registries
reperfusion
stroke
HAL domain(s) :
Sciences du Vivant [q-bio]
English abstract : [en]
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 ...
Show more >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.Show less >
Show more >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.Show less >
Language :
Anglais
Audience :
Internationale
Popular science :
Non
Administrative institution(s) :
Université de Lille
CHU Lille
CHU Lille
Submission date :
2023-11-15T08:10:05Z
2023-12-14T10:48:14Z
2023-12-14T10:48:14Z