Background Early neurological deterioration (END) after endovascular treatment (EVT) in patients with anterior circulation acute ischemic stroke (AIS) is associated with poor outcome. END may remain unexplained by parenchymal hemorrhage (UnEND). We aim to analyze the risk factors of UnEND in the medical management (MM) and EVT arms of the HERMES study.
Methods We conducted a post-hoc analysis of anterior AIS patients who underwent EVT for proximal anterior occlusions. Risk factors of UnEND, defined as a worsening of ≥4 points between baseline National Institutes of Health Stroke Scale (NIHSS) and NIHSS at 24 hours without hemorrhage, were compared between both arms using mixed logistic regression models adjusted for baseline characteristics. An interaction analysis between the EVT and MM arms for risk factors of UnEND was conducted.
Results Among 1723 patients assessable for UnEND, 160 patients experienced an UnEND (9.3%), including 9.1% (78/854) in the EVT arm and 9.4% (82/869) in the MM arm. There was no significant difference in the incidence of UnEND between the two study arms. In the EVT population, independent risk factors of UnEND were lower baseline NIHSS, higher baseline glucose, and lower collateral grade. In the MM population, the only independent predictor of UnEND was higher baseline glucose. However, we did not demonstrate an interaction between EVT and MM for baseline factors as risk factors of UnEND. UnEND was, similarly in both treatment groups, a significant predictor of unfavorable outcome in both the EVT (p<0.001) and MM (p<0.001) arms.
Conclusions UnEND is not an uncommon event, with a similar rate which ever treatment arm is considered. In the clinical scenario of AIS due to large vessel occlusion, no patient-related factor seems to increase the risk for UnEND when treated by EVT compared with MM.
Data availability statement
Data are available upon reasonable request. Please contact us.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
Contributors All coauthors significantly contributed to the study reporting, conception and design; RB, MG, KWM, HD, DWJD, CBLMM, WhvZ, TGJ, PJM, AMD, RJvO, SBB, BC, PW, MDH, JLS, FG, CW, RJ, FG, SB, ON. Acquisition: RB, MG, KWM, HD, DWJD, CBLMM, WhvZ, TGJ, PJM, AMD, RJvO, SBB, BC, PW, MDH, JLS, FG, CW, RJ, FG, SB. Data or analysis: RB, MG, SBB, FG. Interpretation of data: RB, MG, SBB, FG, ON. Drafting the manuscript: RB, MG, KWM, DWJD, CBLMM, WhvZ, PJM, RJvO, SBB, BC, PW, MDH, JLS, FG, CW, FG, ON. RB is the guarantor of full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.
Funding The HERMES Collaboration was funded by a grant from Medtronic LLC to the University of Calgary.
Competing interests PW is member of the editorial board of the Journal of Neurointerventional Surgery.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.