Dhairya A Lakhani, Hamza A Salim, Vivek Yedavalli, Basel Musmar, Fathi Milhem, Nimer Adeeb, Tobias Djamsched Faizy, Motaz Daraghma, Kareem El Naamani, Nils Henninger, Sri Hari Sundararajan, Anna Kuhn, Jane Khalife, Sherief Ghozy, Luca Scarcia, Leonard Yeo, Benjamin Yq Tan, Robert Regenhardt, Jeremy Heit, Nicole Mariantonia Cancelliere, Aymeric Rouchaud, Jens Fiehler, Sunil A Sheth, Ajit S Puri, Christian Dyzmann, Marco Colasurdo, Leonardo Renieri, João Pedro Filipe, Pablo Harker, Răzvan Alexandru Radu, Mohamad Abdalkader, Piers Klein, Thomas Marrota, Julian Spears, Takahiro Ota, Ashkan Mowla, Pascal Jabbour, Arundhati Biswas, Frederic Clarencon, James E Siegler, Thanh N Nguyen, Ricardo Varela, Amanda Baker, Muhammed Amir Essibayi, David Altschul, Nestor Gonzalez, Markus Möhlenbruch, Vincent Costalat, Benjamin Gory, Christian Stracke, Constantin Hecker, Gaultier Marnat, Hamza Shaikh, Christoph Griessenaur, David S Liebeskind, Alessandro Pedicelli, Andrea Alexandre, Illario Tancredi, Erwah Kalsoum, Boris Lubicz, Aman B Patel, Vitor Mendes Pereira, Max Wintermark, Adrien Guenego, Adam Dmytriw
{"title":"Factors associated with Early Neurological Deterioration in Minor Distal Medium Vessel Acute Ischemic Stroke: A Multinational Multicenter Study.","authors":"Dhairya A Lakhani, Hamza A Salim, Vivek Yedavalli, Basel Musmar, Fathi Milhem, Nimer Adeeb, Tobias Djamsched Faizy, Motaz Daraghma, Kareem El Naamani, Nils Henninger, Sri Hari Sundararajan, Anna Kuhn, Jane Khalife, Sherief Ghozy, Luca Scarcia, Leonard Yeo, Benjamin Yq Tan, Robert Regenhardt, Jeremy Heit, Nicole Mariantonia Cancelliere, Aymeric Rouchaud, Jens Fiehler, Sunil A Sheth, Ajit S Puri, Christian Dyzmann, Marco Colasurdo, Leonardo Renieri, João Pedro Filipe, Pablo Harker, Răzvan Alexandru Radu, Mohamad Abdalkader, Piers Klein, Thomas Marrota, Julian Spears, Takahiro Ota, Ashkan Mowla, Pascal Jabbour, Arundhati Biswas, Frederic Clarencon, James E Siegler, Thanh N Nguyen, Ricardo Varela, Amanda Baker, Muhammed Amir Essibayi, David Altschul, Nestor Gonzalez, Markus Möhlenbruch, Vincent Costalat, Benjamin Gory, Christian Stracke, Constantin Hecker, Gaultier Marnat, Hamza Shaikh, Christoph Griessenaur, David S Liebeskind, Alessandro Pedicelli, Andrea Alexandre, Illario Tancredi, Erwah Kalsoum, Boris Lubicz, Aman B Patel, Vitor Mendes Pereira, Max Wintermark, Adrien Guenego, Adam Dmytriw","doi":"10.1177/17474930251381946","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Patients with acute ischemic stroke secondary to distal and medium vessel occlusion (AIS-DMVO) and minor strokes present a challenge in determining the most appropriate emergent treatment. Factors leading to early neurological deterioration (END) in this patient population are understudied, but END is known to result in poor functional outcomes. Therefore, we aimed to investigate the factors contributing to END in minor AIS-DMVO cases.</p><p><strong>Methods: </strong>We included patients with AIS-DMVO and minor strokes from 37 sites across North America, Asia, and Europe. Minor stroke was defined as a baseline National Institutes of Health Stroke Scale (NIHSS) score of ≤ 5. The primary outcome measure, END, was defined as a shift of ≥ 4 points in the NIHSS score at day one after treatment compared to baseline. Univariable and multivariable logistic regression analyses were performed to identify factors associated with END.</p><p><strong>Results: </strong>Among 559 consecutive patients with DMVO and minor strokes, END was reported in 68 patients. In multivariable analysis, mechanical thrombectomy (MT) was independently associated with higher odds of END (aOR 2.37; 95% CI: 1.12-5.02; p = 0.02), while intravenous thrombolysis (IVT) was associated with lower odds of END (aOR 0.46; 95% CI: 0.26-0.81; p = 0.008). However, the association between MT and END was no longer statistically significant in the IPTW-adjusted analysis (OR 1.65; 95% CI: 0.69-3.98; p = 0.26). Hypertension and antiplatelet use at baseline were also independently associated with END. Among MT-treated patients, successful and excellent recanalization and first-pass effect were protective against END.</p><p><strong>Conclusion: </strong>MT was associated with END in patients with minor AIS-DMVO, although this association was not significant after IPTW adjustment. IVT was independently associated with reduced risk of END. These findings support careful patient selection and further study in randomized trials.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251381946"},"PeriodicalIF":8.7000,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Stroke","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/17474930251381946","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Patients with acute ischemic stroke secondary to distal and medium vessel occlusion (AIS-DMVO) and minor strokes present a challenge in determining the most appropriate emergent treatment. Factors leading to early neurological deterioration (END) in this patient population are understudied, but END is known to result in poor functional outcomes. Therefore, we aimed to investigate the factors contributing to END in minor AIS-DMVO cases.
Methods: We included patients with AIS-DMVO and minor strokes from 37 sites across North America, Asia, and Europe. Minor stroke was defined as a baseline National Institutes of Health Stroke Scale (NIHSS) score of ≤ 5. The primary outcome measure, END, was defined as a shift of ≥ 4 points in the NIHSS score at day one after treatment compared to baseline. Univariable and multivariable logistic regression analyses were performed to identify factors associated with END.
Results: Among 559 consecutive patients with DMVO and minor strokes, END was reported in 68 patients. In multivariable analysis, mechanical thrombectomy (MT) was independently associated with higher odds of END (aOR 2.37; 95% CI: 1.12-5.02; p = 0.02), while intravenous thrombolysis (IVT) was associated with lower odds of END (aOR 0.46; 95% CI: 0.26-0.81; p = 0.008). However, the association between MT and END was no longer statistically significant in the IPTW-adjusted analysis (OR 1.65; 95% CI: 0.69-3.98; p = 0.26). Hypertension and antiplatelet use at baseline were also independently associated with END. Among MT-treated patients, successful and excellent recanalization and first-pass effect were protective against END.
Conclusion: MT was associated with END in patients with minor AIS-DMVO, although this association was not significant after IPTW adjustment. IVT was independently associated with reduced risk of END. These findings support careful patient selection and further study in randomized trials.
期刊介绍：
The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
