Early neurological deterioration in patients with minor stroke due to isolated M2 occlusion undergoing medical management: a retrospective multicenter study

Abstract

BackgroundPatients with minor stroke and M2 occlusion undergoing best medical management (BMM) may face early neurological deterioration (END) that can lead to poor long-term outcome. In case of END, rescue mechanical thrombectomy (rMT) seems beneficial. Our study aimed to define factors relevant to clinical outcome in patients undergoing BMM with the possibility of rMT on END, and find predictors of END.MethodsPatients with M2 occlusion and a baseline National Institutes of Health Stroke Scale (NIHSS) score≤5 that received either BMM only or rMT on END after BMM were extracted from the databases of 16 comprehensive stroke centers. Clinical outcome measures were a 90-day modified Rankin Scale (mRS) score of 0–1 or 0–2, and occurrence of END.ResultsAmong 10 169 consecutive patients with large vessel occlusion admitted between 2016 and 2021, 208 patients were available for analysis. END was reported in 87 patients that were therefore all subjected to rMT. In a logistic regression model, END (OR 3.386, 95% CI 1.428 to 8.032), baseline NIHSS score (OR 1.362, 95% CI 1.004 to 1.848) and a pre-event mRS score=1 (OR 3.226, 95% CI 1.229 to 8.465) were associated with unfavorable outcome. In patients with END, successful rMT was associated with favorable outcome (OR 4.549, 95% CI 1.098 to 18.851). Among baseline clinical and neuroradiological features, presence of atrial fibrillation was a predictor of END (OR 3.547, 95% CI 1.014 to 12.406).ConclusionPatients with minor stroke due to M2 occlusion and atrial fibrillation should be closely monitored for possible worsening during BMM and, in this case, promptly considered for rMT.

Study protocol: Early neurological deterioration in patients with minor stroke, frequency, predictors, and outcomes in Vietnam single-centre study

“…Research conducted across multiple centres and looking back at past cases has revealed that using endovascular mechanical thrombectomy does not provide any advantage over other treatment approaches for minor stroke patients with isolated M2 occlusion [ 20 ]. To reduce poor clinical outcomes and complications, early identification of risk factors and closely monitoring may help prevent complications and maximize the benefits of endovascular thrombectomy [ 21 , 22 ]. Intracranial artery stenosis is more common in Asians than in Westerners.…”

Optimizing early neurological deterioration prediction in acute ischemic stroke patients following intravenous thrombolysis: a LASSO regression model approach

“…Building upon our current model’s foundations, the inclusion of cerebral artery occlusion location as a variable represents a promising direction for future enhancements. Recognizing the significant influence of occlusion site, particularly for M2 or more distal occlusions ( Broccolini et al, 2023 ), on the risk of END opens avenues for refining our predictive capabilities. This consideration aligns with the growing demand for precision medicine, where understanding the intricate relationship between specific stroke characteristics and patient outcomes can lead to more tailored and effective interventions.…”

Early apixaban administration considering the size of infarction and functional outcome in acute ischemic stroke

“…In the context of multivariable analysis, several factors exhibited independent associations with favorable outcomes. These factors included a previous history of stroke (OR, 0.47 [0.24-0.92]; p = 0.027), initial NIHSS score (OR, 0.81 [0.76-0.87]; p < 0.001), large lesion size (OR, 0.24 [0.09-0.65]; p = 0.005), and early initiation of apixaban (OR, 2.75 [1.44-5.28]; p = 0.002), as detailed in Tables 2, 3.…”

“…Atrial fibrillation-related ischemic stroke (AF-stroke) is associated with an unfavorable prognosis compared to other stroke causes (1,2), characterized by a heightened risk of progression, hemorrhagic transformation (HT), and early recurrent ischemic stroke (ERIS) (3)(4)(5)(6)(7)(8). Nevertheless, optimizing antithrombotic treatment for enhanced AF-stroke prognosis remains a challenge.…”