Predictors of Unexplained Early Neurological Deterioration After Endovascular Treatment for Acute Ischemic Stroke
Authors: Girot Jean-Baptiste , Richard Sébastien , Gariel Florent , Sibon Igor , Labreuche Julien , Kyheng Maéva , Gory Benjamin , Dargazanli Cyril , Maier Benjamin , Consoli Arturo , Daumas-Duport Benjamin , Lapergue Bertrand , Bourcier Romain , Piotin Michel , Blanc Raphael , Redjem Hocine , Escalard Simon , Desilles Jean-Philippe , Ciccio Gabriele , Smajda Stanislas , Mazighi Mikael , Obadia Mikael , Sabben Candice , Peres Roxanne , Corabianu Ovide , de Broucker Thomas , Smadja Didier , Alamowitch Sonia , Ille Olivier , Manchon Eric , Garcia Pierre-Yves , Taylor Guillaume , Ben Maacha Malek , Wang Adrien , Evrard Serge , Tchikviladze Maya , Ajili Nadia , Weisenburger David , Gorza Lucas , Buard Géraldine , Coskun Oguzhan , Di Maria Federico , Rodesh Georges , Zimatore Sergio , Leguen Morgan , Gratieux Julie , Pico Fernando , Rakotoharinandrasana Haja , Tassan Philippe , Poll Roxanna , Marinier Sylvie , Nighoghossian Norbert , Riva Roberto , Eker Omer , Turjman Francis , Derex Laurent , Cho Tae-Hee , Mechtouff Laura , Claire Lukaszewicz Anne , Philippeau Frédéric , Cakmak Serkan , Blanc-Lasserre Karine , Vallet Anne-Evelyne , Marnat Gaultier , Barreau Xavier , Berge Jérôme , Veunac Louis , Menegon Patrice , Lucas Ludovic , Olindo Stéphane , Renou Pauline , Sagnier Sharmila , Poli Mathilde , Debruxelles Sabrina , Tourdias et Jean-Sebastien Liegey Thomas , Detraz Lili , Alexandre Pierre-Louis , Roy Monica , Lenoble Cédric , L’allinec Vincent , Desal Hubert , Guillon Benoît , de Gaalon Solène , Preterre Cécile , Bracard Serge , Anxionnat René , Braun Marc , Derelle Anne-Laure , Tonnelet Romain , Liao Liang , Zhu François , Schmitt Emmanuelle , Planel Sophie , Humbertjean Lisa , Mione Gioia , Lacour Jean-Christophe , Bonnerot Mathieu , Riou-Comte Nolwenn , Macian-Montoro Francisco , Saleme Suzanna , Mounayer Charbel , Rouchaud Aymeric , Costalat Vincent , Arquizan Caroline , Gascou Grégory , Lefèvre Pierre-Henri , Derraz Imad , Riquelme Carlos , Gaillard Nicolas , Mourand Isabelle , Corti Lucas , Francois Eugene , Vannier Stéphane , Ferre Jean-Christophe , Raoult Helene , Ronziere Thomas , Lassale Maria , Paya Christophe , Gauvrit Jean-Yves , Tracol Clément , Langnier-Lemercier Sophie , Samson Yves , Rosso Charlotte , Leger Anne , Deltour Sandrine , Clarencon Frederic , Shotar Eimad , Spelle Laurent , Denier Christian , Chassin Olivier , Chalumeau Vanessa , Caroff Jildaz , Chassin Olivier , Venditti Laura , Turc Guillaume , Naggara Glivier , Boulouis Gregoire , Ben Hassen Waghih , Seners Pierre , Viguier Alain , Cognard Christophe , Christine Januel Anne , Olivot Jean-Marc , Raposo Nicolas , Bonneville Fabrice , Touze Emmanuel , Barbier Charlotte , Schneckenburger Romain , Boulanger Marion , Cogez Julien , Guettier Sophie 
Published: September 2020

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.