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Predictors and outcome of early neurological deterioration after endovascular thrombectomy: a secondary analysis of the DIRECT-MT trial
  1. Miaoyi Zhang1,
  2. Pengfei Xing2,
  3. Jie Tang1,
  4. Langfeng Shi1,
  5. Pengfei Yang2,
  6. Yongwei Zhang2,
  7. Lei Zhang2,
  8. Ya Peng3,
  9. Sheng Liu4,
  10. Liyong Zhang5,
  11. Jianhui Fu1,
  12. Jianmin Liu2
  13. On behalf of the DIRECT-MT Investigators
    1. 1Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
    2. 2Neurovascular Center, Changhai Hospital, Shanghai, China
    3. 3Department of Neurosurgery, The First People's Hospital of Changzhou, Changzhou, China
    4. 4Department of Interventional Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
    5. 5Department of Vascular Neurosurgery, Liaocheng Brain Hospital, Liaocheng, China
    1. Correspondence to Professor Jianhui Fu, the department of Neurology, Huashan Hospital Fudan University, Shanghai, China; jianhuifu{at}126.com; Dr Liyong Zhang, Department of Vascular Neurosurgery, Liaocheng Brain Hospital, Liaocheng, China; 13346256936{at}163.com

    Abstract

    Background There is uncertainty regarding the predictors of early neurological deterioration (END) after endovascular thrombectomy in patients with acute ischemic stroke (AIS). Limited studies have focused on the effect of END on functional outcome. Our aim was to determine the predictors of END after endovascular thrombectomy in AIS and its effect on functional outcome at 90 days.

    Methods This is a secondary analysis of the DIRECT-MT trial. Patients who failed to complete endovascular thrombectomy were additionally excluded. END was defined as ≥4-point increase in National Institutes of Health Stroke Scale score between admission and 24 hours after endovascular thrombectomy. Multivariable logistic regression was used to identify predictors for END and its effect on the modified Rankin Scale (mRS) score at 90 days.

    Results Of 591 patients enrolled, 111 (18.8%) had postoperative END, which was associated with higher ordinal mRS score at 90 days (adjusted common OR (aOR) 6.968, 95% CI 4.444 to 10.926). Non-modifiable factors included baseline Alberta Stroke Program Early CT Score (aOR 0.883, 95% CI 0.790 to 0.987), systolic blood pressure (aOR 1.017, 95% CI 1.006 to 1.028), glucose level (aOR 1.178, 95% CI 1.090 to 1.273), collateral status (aOR 0.238, 95% CI 0.093 to 0.608), occlusion site (aOR 0.496, 95% CI 0.290 to 0.851) and the presence of an anterior communicating artery (aOR 0.323, 95% CI 0.148 to 0.707). Admission-to-groin puncture time (aOR 1.010, 95% CI 1.003 to 1.017), general anesthesia (aOR 2.299, 95% CI 1.193 to 4.444), number of passes (aOR 1.561, 95% CI 1.243 to 1.961) and contrast extravasation (aOR 6.096, 95% CI 1.543 to 24.088) were modifiable predictors for END.

    Conclusions Postoperative END is associated with adverse functional outcome. Several non-modifiable and modifiable factors can predict END and support future treatment decision-making to improve the potential utility of endovascular thrombectomy.

    Trial registration number DIRECT-MT ClinicalTrials.gov NCT03469206.

    • Thrombectomy
    • Stroke

    Data availability statement

    Data are available upon reasonable request. Data are available upon reasonable request and requests to access the dataset from qualified researchers trained in human subject confidentiality protocols may be sent to the DIRECT-MT investigators at direct_mt@163.com.

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    Data availability statement

    Data are available upon reasonable request. Data are available upon reasonable request and requests to access the dataset from qualified researchers trained in human subject confidentiality protocols may be sent to the DIRECT-MT investigators at direct_mt@163.com.

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    Footnotes

    • MZ and PX are joint first authors.

    • LZ and JF contributed equally.

    • Collaborators DIRECT-MT Investigators- Executive Committee: Prof. Jianmin Liu, Department of Neurosurgery, Naval Medical University Changhai hospital, Shanghai, China. Prof. Benqiang Deng, Department of Neurology, Naval Medical University Changhai hospital, Shanghai, China. Prof. Bo Hong, Department of Neurosurgery, Naval Medical University Changhai hospital, Shanghai, China. Prof. Kaifu Ke, Department of Neurology, Affiliated Hospital of Nantong University, Nantong, China. Prof. Min Lou, Department of Neurology, Second Affiliated Hospital of Zhejiang University, Hangzhou, China. Prof. Congguo Yin, Department of Neurology, Hangzhou First People's Hospital of Zhejiang University, Hangzhou, China. Prof. Peng Wang, Department of Neurology, Taizhou First People's Hospital of Wenzhou Medical University, Taizhou, China. Prof. Wenhuo Chen, Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China. Prof. Anding Xu, Department of Neurology, First Affiliated Hospital of Jinan University, Guangzhou, China. Prof. Tianxiao Li, Department of Radiology, Henan Provincial People’s Hospital of Zhengzhou University, Zhengzhou, China Prof. Liping Wei, Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang, China. Prof. Conghui Li, Department of Neurosurgery, First Hospital of Hebei Medical University, Shijiazhuang, China. Prof. Qiyi Zhu, Department of Neurology, Linyi People’s Hospital of Qingdao University, Linyi, China. Prof. Dianjing Sun, Department of Radiology, Yantaishan Hospital of Shandong First Medical University, Yantai, China. Prof. Hui Liang, Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai, China. Prof. Jiyue Wang, Department of Neurosurgery, Liaocheng People’s Hospital of Shandong First Medical University, Liaocheng, China Prof. Shouchun Wang, Department of Neurology, First Affiliated Hospital of Jilin University, Changchun, China. Prof. Ya Peng, Department of Neurosurgery, Third Affiliated Hospital of Soochow University, Changzhou, China. Prof. Yun Xu, Department of Neurology, Nanjing Drum Tower Hospital of Nanjing University, Nanjing, China. Prof. Hongchao Shi, Department of Neurology, Nanjing First Hospital of Nanjing Medical University, Nanjing, China. Prof. Qi Fang, Department of Neurology, First Affiliated Hospital of Soochow University, Suzou, China. Prof. Haibin Shi, Department of Radiology, Jiangsu Provincial People’s Hospital of Nanjing Medical University, Nanjing, China. Prof. Meng Zhang, Department of Neurology, Daping Hospital of Army Medical University, Chongqing, China. Prof. Shengli Chen, Department of Neurology, Chongqing Three Gorges Central Hospital, Chongqing, China Prof. Tong Li, Department of Neurology, Third Affiliated Hospital of Guangxi Medical University, Nanning, China. Prof. Xincan Yue, Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou, China. Prof. Huaizhang Shi, Department of Neurosurgery, First Affiliated Hospital of Harbin Medical University, Harbin, China. Prof. Changchun Jiang, Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University, Baotou, China. Prof. Guoping Wang, Department of Neurology, First Affiliated Hospital of University of Science and Technology of China (USTC), Hefei, China.

    • Contributors MZ and PX are co-first authors and contributed equally to the work. Conception or design of the article: MZ, PX, LZ, JF, and JL. Drafting of the manuscript: MZ and PX. Acquisition, analysis, or interpretation of data: JT, LS, PY, YZ, LZ, YP, SL. Revision of the manuscript for important intellectual content: All authors. Final approval of the version: LZ, JF, and JL.The author acting as guarantor:JF.

    • 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.

    • Competing interests None declared.

    • 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.

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