Delayed neurological improvement after endovascular treatment for acute large vessel occlusion: data from ANGEL-ACT registry.

A subgroup of patients with acute large vessel occlusion (ALVO) may experience delayed neurological improvement (DNI) after endovascular treatment (EVT). Our study aimed to investigate the incidence and independent predictors of DNI in patients with ALVO after EVT. We selected subjects from ANGEL-ACT Registry. The definition of DNI is patients with ALVO who did not experience early neurological improvement (ENI) despite complete recanalization after EVT. These patients achieved a 90-day favorable outcome assessed by a modified Rankin Scale (mRS) score. We defined ENI as a ≥ 4-point decrease in the National Institutes of Health Stroke Scale (NIHSS) between baseline and 24 h or NIHSS of 0 or 1 at 24 h, with complete recanalization after EVT. We performed logistic regression analyses to determine the independent predictors of DNI. Among the 1056 enrolled patients, 406 (38.4%) did not experience ENI. 106 (26.1%) patients without ENI achieved DNI. On Multivariate analysis, lower admission NIHSS score (odds ratio [OR] = 1.17,95% confidence interval [CI]: 1.11-1.23, P < 0.001), underlying ICAD (OR = 2.03, 95% CI: 1.07-3.85, P = 0.029) and absence of general anesthesia (OR = 2.13, 95% CI: 1.24-3.64, P = 0.006) were independent predictors of DNI. DNI occurred in 26.1% of patients with ALVO who did not experience ENI after EVT. Our study identified several independent predictors of DNI that should be highly considered in daily clinical practice to improve ALVO management.

Sun D ，- R ，Huo X ，Jia B ，Tong X ，Ma G ，Wang A ，Ma N ，Gao F ，Mo D ，Miao Z ... -  《-》

Unexplained early neurological deterioration after endovascular treatment for acute large vessel occlusion: incidence, predictors, and clinical impact: Data from ANGEL-ACT registry.

Early neurological deterioration (END) may occur in some patients with acute large vessel occlusion (LVO) undergoing endovascular treatment (EVT). Despite several clear causes of END, such as symptomatic intracranial hemorrhage, failure of recanalization, and intraprocedure complications, a particular END, termed unexplained END (ENDunexplained), exists. We aimed to investigate the incidence, independent predictors, and clinical impact of ENDunexplained after EVT in patients with acute LVO. Subjects were selected from the ANGEL-ACT registry. ENDunexplained was defined as ≥4-point increase in the National Institutes of Health Stroke Scale (NIHSS) score between baseline and 24 hours after EVT, without the causes listed above. Logistic regression analyses were performed to determine the independent predictors of ENDunexplained, as well as the association between ENDunexplained and 90-day outcomes assessed by modified Rankin Scale (mRS) score. Among the 1557 enrolled patients, the incidence of ENDunexplained was 4.3% (67/1557). Admission NIHSS ≤8 (OR=6.88, 95% CI 3.86 to 12.26, p<0.001), general anesthesia (OR=3.15, 95% CI 1.81 to 5.48, p<0.001), admission neutrophil to lymphocyte ratio >5 (OR=2.82, 95% CI 1.61 to 4.94, p<0.001), and number of EVT attempts >3 (OR=2.11, 95% CI 1.14 to 3.89, p=0.018) were associated independently with a high risk of ENDunexplained. Furthermore, patients with ENDunexplained were associated with a shift toward worse 90-day outcomes (mRS 5 vs 3, common OR=5.24, 95% CI 3.22 to 8.52, p<0.001). ENDunexplained associated with poor 90day outcomes occurred in 4.3% of patients with acute LVO undergoing EVT. Several independent predictors of ENDunexplained were identified in this study, which should be considered in daily practice to improve acute LVO management. http://wwwclinicaltrialsgov NCT03370939.

Sun D ，Tong X ，Huo X ，Jia B ，Raynald ，Wang A ，Ma G ，Ma N ，Gao F ，Mo D ，Song L ，Sun X ，Liu L ，Deng Y ，Li X ，Wang B ，Luo G ，Wang Y ，Miao Z ，ANGEL-ACT study group ... -  《-》

Predictors of good functional outcome in ischaemic stroke patients without delayed neurological improvement after mechanical thrombectomy.

Wrona P ，Wróbel D ，Popadynets V ，Jóźwik J ，Sawczyńska K ，Homa T ，Włodarczyk E ，Pułyk R ，Popiela T ，Słowik A ，Turaj W ... -  《Neurologia i Neurochirurgia Polska》

Delayed Neurological Improvement After Full Endovascular Reperfusion in Acute Anterior Circulation Ischemic Stroke.

Talavera B ，Gómez-Vicente B ，Martínez-Galdámez M ，López-Cancio E ，García-Cabo C ，Castellanos M ，Roel A ，Tejada-Meza H ，Marta-Moreno J ，Pérez-Lázaro C ，Navarro-Pérez MP ，Bravo-Anguiano Y ，Bártulos-Iglesias M ，Tejada-García J ，Rodrigo-Stevens G ，Martínez-Zabaleta M ，de la Riva P ，Timiraos-Fernández JJ ，Del Mar Freijo M ，Luna A ，García-Sánchez JM ，Del Carmen Gil-Alzueta M ，Palacio-Portilla EJ ，Jiménez-López Y ，López-Mesonero L ，Redondo-Robles L ，Mayo-Iscar A ，Arenillas JF ，NORDICTUS Investigators* ... -  《-》

Comparison of predictors of failure of early neurological improvement after successful endovascular treatment for posterior and anterior circulation large vessel occlusion: Data from ANGEL-ACT registry.

Yang X ，Yang J ，Sun D ，Wang A ，Tong X ，Jia B ，Miao Z ，ANGEL-ACT study group ... -  《-》