Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, 100070, Beijing, China.
Department of Neurosurgery , Beijing Fengtai You anmen Hospital , Beijing, China.
J Thromb Thrombolysis. 2023 Jan;55(1):1-8. doi: 10.1007/s11239-022-02712-7. Epub 2022 Oct 27.
A subgroup of patients with acute large vessel occlusion (ALVO) may experience delayed neurological improvement (DNI) after endovascular treatment (EVT). Our study aimed to investigate the incidence and independent predictors of DNI in patients with ALVO after EVT.
We selected subjects from ANGEL-ACT Registry. The definition of DNI is patients with ALVO who did not experience early neurological improvement (ENI) despite complete recanalization after EVT. These patients achieved a 90-day favorable outcome assessed by a modified Rankin Scale (mRS) score. We defined ENI as a ≥ 4-point decrease in the National Institutes of Health Stroke Scale (NIHSS) between baseline and 24 h or NIHSS of 0 or 1 at 24 h, with complete recanalization after EVT. We performed logistic regression analyses to determine the independent predictors of DNI.
Among the 1056 enrolled patients, 406 (38.4%) did not experience ENI. 106 (26.1%) patients without ENI achieved DNI. On Multivariate analysis, lower admission NIHSS score (odds ratio [OR] = 1.17,95% confidence interval [CI]: 1.11-1.23, P < 0.001), underlying ICAD (OR = 2.03, 95% CI: 1.07-3.85, P = 0.029) and absence of general anesthesia (OR = 2.13, 95% CI: 1.24-3.64, P = 0.006) were independent predictors of DNI.
DNI occurred in 26.1% of patients with ALVO who did not experience ENI after EVT. Our study identified several independent predictors of DNI that should be highly considered in daily clinical practice to improve ALVO management.
急性大血管闭塞（ALVO）患者的亚组在血管内治疗（EVT）后可能会出现神经功能改善延迟（DNI）。本研究旨在探讨 EVT 后 ALVO 患者 DNI 的发生率和独立预测因素。
我们从 ANGEL-ACT 登记处中选择研究对象。DNI 的定义为 EVT 后完全再通但未出现早期神经功能改善（ENI）的 ALVO 患者。这些患者在 90 天时通过改良 Rankin 量表（mRS）评分获得良好预后。我们将 ENI 定义为基线和 24 小时之间 NIHSS 评分下降≥4 分或 24 小时时 NIHSS 评分为 0 或 1，并且 EVT 后完全再通。我们进行了逻辑回归分析以确定 DNI 的独立预测因素。
在纳入的 1056 例患者中，406 例（38.4%）未出现 ENI。在 106 例未出现 ENI 的患者中，有 106 例（26.1%）发生了 DNI。多变量分析显示，入院时 NIHSS 评分较低（比值比 [OR] = 1.17，95%置信区间 [CI]：1.11-1.23，P < 0.001）、基底动脉粥样硬化性狭窄（OR = 2.03，95% CI：1.07-3.85，P = 0.029）和未使用全身麻醉（OR = 2.13，95% CI：1.24-3.64，P = 0.006）是 DNI 的独立预测因素。
在 EVT 后未出现 ENI 的 ALVO 患者中，有 26.1%发生了 DNI。本研究确定了 DNI 的几个独立预测因素，在日常临床实践中应高度考虑这些因素，以改善 ALVO 的管理。
