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":"轻度远端中血管急性缺血性卒中早期神经功能恶化的相关因素：一项多国多中心研究。","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":"{\"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}","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
摘要
背景：急性缺血性卒中继发于远端和中端血管闭塞（AIS-DMVO）和轻微中风的患者在确定最合适的紧急治疗方案方面面临挑战。导致该患者群体早期神经功能恶化（END）的因素尚未得到充分研究，但已知END会导致较差的功能预后。因此，我们的目的是探讨在轻微AIS-DMVO病例中导致END的因素。方法：我们纳入了来自北美、亚洲和欧洲37个地点的AIS-DMVO和轻微卒中患者。轻度脑卒中定义为基线美国国立卫生研究院脑卒中量表（NIHSS）评分≤5分。主要结局指标END定义为治疗后第一天NIHSS评分较基线偏移≥4分。进行单变量和多变量logistic回归分析以确定与END相关的因素。结果：在559例DMVO合并轻微卒中患者中，68例患者报告了END。在多变量分析中，机械取栓（MT）与较高的END发生率独立相关（aOR 2.37; 95% CI: 1.12-5.02; p = 0.02），静脉溶栓（IVT）与较低的END发生率独立相关（aOR 0.46; 95% CI: 0.26-0.81; p = 0.008）。然而，在iptw校正分析中，MT和END之间的关联不再具有统计学意义（OR 1.65; 95% CI: 0.69-3.98; p = 0.26）。基线时高血压和抗血小板使用也与END独立相关。在接受mt治疗的患者中，成功和优秀的再通和首次通过效果对END具有保护作用。结论：轻度AIS-DMVO患者MT与END相关，但IPTW调整后这种关联不显著。IVT与降低END风险独立相关。这些发现支持谨慎的患者选择和进一步的随机试验研究。
Factors associated with Early Neurological Deterioration in Minor Distal Medium Vessel Acute Ischemic Stroke: A Multinational Multicenter Study.
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.
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