Frontiers in Neurology (Aug 2022)

Effectiveness and safety of EVT in patients with acute LVO and low NIHSS

  • Beom Joon Kim,
  • Bijoy K. Menon,
  • Joonsang Yoo,
  • Jung Hoon Han,
  • Bum Joon Kim,
  • Chi Kyung Kim,
  • Jae Guk Kim,
  • Joon-Tae Kim,
  • Hyungjong Park,
  • Sung Hyun Baik,
  • Moon-Ku Han,
  • Jihoon Kang,
  • Jun Yup Kim,
  • Keon-Joo Lee,
  • Jong-Moo Park,
  • Kyusik Kang,
  • Soo Joo Lee,
  • Jae-Kwan Cha,
  • Dae-Hyun Kim,
  • Jin-Heon Jeong,
  • Tai Hwan Park,
  • Sang-Soon Park,
  • Kyung Bok Lee,
  • Jun Lee,
  • Keun-Sik Hong,
  • Yong-Jin Cho,
  • Hong-Kyun Park,
  • Byung-Chul Lee,
  • Kyung-Ho Yu,
  • Mi-Sun Oh,
  • Dong-Eog Kim,
  • Wi-Sun Ryu,
  • Kang-Ho Choi,
  • Jay Chol Choi,
  • Joong-Goo Kim,
  • Jee-Hyun Kwon,
  • Wook-Joo Kim,
  • Dong-Ick Shin,
  • Kyu Sun Yum,
  • Sung-Il Sohn,
  • Jeong-Ho Hong,
  • Chulho Kim,
  • Sang-Hwa Lee,
  • Juneyoung Lee,
  • Mohammed A. Almekhlafi,
  • Andrew Demchuk,
  • Hee-Joon Bae

DOI
https://doi.org/10.3389/fneur.2022.955725
Journal volume & issue
Vol. 13

Abstract

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Background and purposeThere is much uncertainty in endovascular treatment (EVT) decisions in patients with acute large vessel occlusion (LVO) and mild neurological deficits.MethodsFrom a prospective, nationwide stroke registry, all patients with LVO and baseline NIHSS <6 presenting within 24 h from the time last known well (LKW) were included. Early neurological deterioration (END) developed before EVT was prospectively collected as an increasing total NIHSS score ≥2 or any worsening of the NIHSS consciousness or motor subscores during hospitalization not related to EVT. Significant hemorrhage was defined as PH2 hemorrhagic transformation or hemorrhage at a remote site. The modified Rankin Scale (mRS) was prospectively collected at 3 months.ResultsAmong 1,083 patients, 149 (14%) patients received EVT after a median of 5.9 [3.6–12.3] h after LKW. In propensity score-matched analyses, EVT was not associated with mRS 0-1 (matched OR 0.99 [0.63–1.54]) but increased the risk of a significant hemorrhage (matched OR, 4.51 [1.59–12.80]). Extraneous END occurred in 207 (19%) patients after a median of 24.5 h [IQR, 13.5–41.9 h] after LKW (incidence rate, 1.41 [95% CI, 1.23–1.62] per 100 person-hours). END unrelated to EVT showed a tendency to modify the effectiveness of EVT (P-for-interaction, 0.08), which decreased the odds of having mRS 0–1 in mild LVO patients without END (adjusted OR, 0.63 [0.40–0.99]).ConclusionsThe use of EVT in patients with acute LVO and low NIHSS scores may require the assessment of individual risks of early deterioration, hemorrhagic complications and expected benefit.

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