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Incidence and mechanism of early neurological deterioration after endovascular thrombectomy

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Abstract

Background

We investigated the prevalence and mechanisms of neurological deterioration after endovascular thrombectomy.

Methods

Between 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.

Results

A 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 72 h. 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 3–6 at 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.

Conclusion

Neurological deterioration frequently occurs after endovascular thrombectomy, and the risk factors of END differ according to the mechanism of END.

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Acknowledgements

The work was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2016R1D1A1B03933891). The funding has no role in the design, collection, analysis, or interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, 224-1, Heukseok-dong, Dongjak-gu, Seoul, 156-755, South Korea

    Jeong-Min Kim, Jae-Han Bae, Kwang-Yeol Park, Suk-Won Ahn, Hae-Won Shin, Su-Hyun Han & Il-Han Yoo

  2. Department of Neuroradiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea

    Woong Jae Lee & Jun Soo Byun

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  1. Jeong-Min Kim
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Correspondence to Kwang-Yeol Park.

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Kim, JM., Bae, JH., Park, KY. et al. Incidence and mechanism of early neurological deterioration after endovascular thrombectomy. J Neurol 266, 609–615 (2019). https://doi.org/10.1007/s00415-018-09173-0

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  • DOI: https://doi.org/10.1007/s00415-018-09173-0

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