Effectiveness and safety of EVT in patients with acute LVO and low NIHSS

• Published in: Frontiers in neurology Vol. 13; p. 955725
• Main Authors: Kim, Beom Joon, Menon, Bijoy K, Yoo, Joonsang, Han, Jung Hoon, Kim, Bum Joon, Kim, Chi Kyung, Kim, Jae Guk, Kim, Joon-Tae, Park, Hyungjong, Baik, Sung Hyun, Han, Moon-Ku, Kang, Jihoon, Kim, Jun Yup, Lee, Keon-Joo, Park, Jong-Moo, Kang, Kyusik, Lee, Soo Joo, Cha, Jae-Kwan, Kim, Dae-Hyun, Jeong, Jin-Heon, Park, Tai Hwan, Park, Sang-Soon, Lee, Kyung Bok, Lee, Jun, Hong, Keun-Sik, Cho, Yong-Jin, Park, Hong-Kyun, Lee, Byung-Chul, Yu, Kyung-Ho, Oh, Mi-Sun, Kim, Dong-Eog, Ryu, Wi-Sun, Choi, Kang-Ho, Choi, Jay Chol, Kim, Joong-Goo, Kwon, Jee-Hyun, Kim, Wook-Joo, Shin, Dong-Ick, Yum, Kyu Sun, Sohn, Sung-Il, Hong, Jeong-Ho, Kim, Chulho, Lee, Sang-Hwa, Lee, Juneyoung, Almekhlafi, Mohammed A, Demchuk, Andrew, Bae, Hee-Joon
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 05.08.2022
• Subjects: CRCS-K; early neurological deterioration; endovascular recanalization; low NIHSS score; mild stroke; multicenter registry; Neurology; low NIHSS score; multicenter registry; endovascular recanalization; CRCS-K; mild stroke; early neurological deterioration
• ISSN: 1664-2295; 1664-2295
• DOI: 10.3389/fneur.2022.955725

There is much uncertainty in endovascular treatment (EVT) decisions in patients with acute large vessel occlusion (LVO) and mild neurological deficits. From a prospective, nationwide stroke registry, all patients with LVO and baseline NIHSS <6 presenting within 24 h from the time last known well (LKW) were included. Early neurological deterioration (END) developed before EVT was prospectively collected as an increasing total NIHSS score ≥2 or any worsening of the NIHSS consciousness or motor subscores during hospitalization not related to EVT. Significant hemorrhage was defined as PH2 hemorrhagic transformation or hemorrhage at a remote site. The modified Rankin Scale (mRS) was prospectively collected at 3 months. Among 1,083 patients, 149 (14%) patients received EVT after a median of 5.9 [3.6-12.3] h after LKW. In propensity score-matched analyses, EVT was not associated with mRS 0-1 (matched OR 0.99 [0.63-1.54]) but increased the risk of a significant hemorrhage (matched OR, 4.51 [1.59-12.80]). Extraneous END occurred in 207 (19%) patients after a median of 24.5 h [IQR, 13.5-41.9 h] after LKW (incidence rate, 1.41 [95% CI, 1.23-1.62] per 100 person-hours). END unrelated to EVT showed a tendency to modify the effectiveness of EVT (P-for-interaction, 0.08), which decreased the odds of having mRS 0-1 in mild LVO patients without END (adjusted OR, 0.63 [0.40-0.99]). The use of EVT in patients with acute LVO and low NIHSS scores may require the assessment of individual risks of early deterioration, hemorrhagic complications and expected benefit.