Background Early neurologic deterioration (END) following ischemic stroke is a serious event and is associated with poor outcomes. However, the incidence and predictors of END after stroke thrombectomy for emergent large vessel occlusion are largely unknown.
Methods The baseline characteristics of patients enrolled in the COMPASS trial (NCT02466893) were analyzed. The primary outcome was worsening of ≥4 National Institutes of Health Stroke Scale (NIHSS) points 24 hours post thrombectomy (4+ END24) and the secondary outcome was deterioration of ≥2 points (2+ END24).
Results Among 270 patients, 27 (10%) developed 4+ END24 and 42 (16%) had 2+ END24. Those with 4+ END24 were older (76.4±12.9 vs 70.9±12.9 years; p=0.04), had a higher prevalence of hypertension (96% vs 69%; p=0.003), diabetes (41% vs 27%; p=0.13) and higher pretreatment systolic blood pressure (SBP) (170.4±32.6 vs 157.6±28.1 mmHg; p=0.03). More 4+ END24 patients had failed reperfusion: Thrombolysis in Cerebral Infarction ≤2a (26% vs 8%; p=0.003). In unadjusted analysis, older patients and those with hypertension, diabetes, elevated SBP and failed reperfusion had higher odds of 4+ END24. In adjusted analysis, age increase by 5 years led to an increase in 4+ END24 of 28%, diabetes increased odds of 2.6 and failed reperfusion increased odds of 4.5. In the multivariable analysis for the secondary outcome, age (OR 1.33; 95% CI 1.109 to 1.593), diabetes (OR 2.7; 95% CI 1.247 to 5.764) and failed reperfusion (OR 7.2; 95% CI 0.055 to 0.349) were also significant predictors of 2+ END24.
Conclusions Older patients with acute ischemic stroke who have a history of diabetes or hypertension, with elevated pretreatment SBP and failed reperfusion are at a higher risk of END following stroke thrombectomy for emergent large vessel occlusion.
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
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Collaborators COMPASS group authors’ disclosures are included in the uploaded document titled " Supplemental Information for Editors only"
Contributors RB: study concept and design, wrote the statistical analysis plan, cleaned and analyzed the data, drafted and revised the paper and accepts full responsibilty for the work and the conduct of the study, had access to the data, and controlled the decision to publish.RB acts as the guarantor. SSN: study design, revised the statistical analysis and the draft paper. EAT: study design, revised the statistical analysis and the draft paper. AT: revised the draft paper. AHS: revised the draft paper. AVA: study design and revised the draft paper. ASA: study design and revised the draft paper. JM: provided dataset from original COMPASS trial, study design, drafted and revised the paper.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.The initial COMPASS trial was funded by Penumbra; however, there was no additional funding for our study-related specific analysis.
Competing interests None
Provenance and peer review Not commissioned; externally peer reviewed.
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