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

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Ischemic stroke
Original research
Early neurological deterioration in patients with minor stroke due to isolated M2 occlusion undergoing medical management: a retrospective multicenter study
  1. Aldobrando Broccolini1,2,
  2. Valerio Brunetti1,
  3. Francesca Colò2,
  4. Andrea M Alexandre3,
  5. Iacopo Valente3,
  6. Anne Falcou4,
  7. Giovanni Frisullo1,
  8. Alessandro Pedicelli3,
  9. Luca Scarcia2,
  10. Irene Scala2,
  11. Pier Andrea Rizzo2,
  12. Simone Bellavia2,
  13. Arianna Camilli2,
  14. Luca Milonia5,
  15. Mariangela Piano6,
  16. Antonio Macera6,
  17. Christian Commodaro7,
  18. Maria Ruggiero7,
  19. Valerio Da Ros8,
  20. Luigi Bellini8,
  21. Guido A Lazzarotti9,
  22. Mirco Cosottini9,
  23. Armando A Caragliano10,
  24. Sergio L Vinci10,
  25. Joseph D Gabrieli11,
  26. Francesco Causin11,
  27. Pietro Panni12,
  28. Luisa Roveri13,
  29. Nicola Limbucci14,
  30. Francesco Arba15,
  31. Marco Pileggi16,
  32. Giovanni Bianco17,
  33. Daniele G Romano18,
  34. Giulia Frauenfelder18,
  35. Vittorio Semeraro19,
  36. Maria P Ganimede20,
  37. Emilio Lozupone21,
  38. Antonio Fasano22,
  39. Elvis Lafe23,
  40. Anna Cavallini24,
  41. Riccardo Russo25,
  42. Mauro Bergui25,
  43. Paolo Calabresi1,2,
  44. Giacomo Della Marca1,2
  1. 1 Neurology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
  2. 2 Catholic University School of Medicine, Rome, Italy
  3. 3 Neuroradiology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
  4. 4 Stroke Unit, University Hospital Policlinico Umberto I, Rome, Italy
  5. 5 Interventional Neuroradiology, University Hospital Policlinico Umberto I, Rome, Italy
  6. 6 Neuroradiology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
  7. 7 Neuroradiology Unit, AUSL Romagna, Cesena, Italy
  8. 8 Department of Biomedicine and Prevention, Fondazione PTV Policlinico 'Tor Vergata', Rome, Italy
  9. 9 Neuroradiology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
  10. 10 Neuroradiology Unit, AOU Policlinico G. Martino, Messina, Italy
  11. 11 Neuroradiology Unit, Policlinico Universitario di Padova, Padua, Italy
  12. 12 Interventional Neuroradiology Unit, IRCCS San Raffaele University Hospital, Milan, Italy
  13. 13 Neurology Unit, IRCCS San Raffaele University Hospital, Milan, Italy
  14. 14 Interventional Neurovascular Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
  15. 15 Stroke Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
  16. 16 Neuroradiology Unit, Neurocenter of Southern Switzerland-EOC, Lugano, Switzerland
  17. 17 Stroke Unit, Neurocenter of Southern Switzerland-EOC, Lugano, Switzerland
  18. 18 Neuroradiology Unit, AOU S. Giovanni di Dio e Ruggi di Aragona, Salerno, Italy
  19. 19 Interventional Radiology Unit, "SS. Annunziata" Hospital, Taranto, Italy
  20. 20 Neuroradiology Unit, "SS. Annunziata" Hospital, Taranto, Italy
  21. 21 Neuroradiology Unit, Vito Fazzi Hospital, Lecce, Italy
  22. 22 Neurology Unit, Vito Fazzi Hospital, Lecce, Italy
  23. 23 Neuroradiology Unit, IRCCS Policlinico San Matteo, Pavia, Italy
  24. 24 Cerebrovascular Diseases Unit, IRCCS Fondazione Mondino, Pavia, Italy
  25. 25 Interventional Neuroradiology, Azienda Ospedaliero Universitaria Citta della Salute e della Scienza di Torino, Turin, Italy
  1. Correspondence to Dr Aldobrando Broccolini, Neurology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy; aldobrando.broccolini{at}policlinicogemelli.it

Abstract

Background Patients 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.

Methods Patients 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.

Results Among 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).

Conclusion Patients 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.

  • stroke
  • thrombolysis
  • thrombectomy

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/jnis-2023-020118

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Twitter @abroccolini1, @Marco_Pileggi, @riccardorusso89

    • Contributors AB, VB, FC, AMA, IV, AF, GF and GDM contributed to study concept or design, acquisition, analysis and interpretation of data and drafting/revision of the manuscript for content. AP, LS, IS, PAR, SB, AC, LM, MP, AM, CC, MR, VDR, LB, GAL, MC, AAC, SLV, JDG, FCa, PP, LR, NL, FA, MPi, GB, DGR, GF, VS, MPG, EL, AF, ELa, AC, RR and MB contributed to the acquisition, analysis and interpretation of data and revision of the manuscript for content. PC contributed to study concept or design and to drafting/revision of the manuscript for content. AB is the guarantor.

    • Funding This work was supported by Ricerca Corrente Reti IRCCS 2022, RCR‐2022‐23682294, Rete IRCCS delle Neuroscienze e della Neuroriabilitazione – RIN, Istituto Virtuale Nazionale Malattie Cerebrovascolari, and by the Italian Ministry of Health RC 2022.

    • 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.