Fujiwara Satoru, Uchida Kazutaka, Ohta Tsuyoshi, Ohara Nobuyuki, Kawamoto Michi, Yamagami Hiroshi, Hayakawa Mikito, Ishii Akira, Iihara Koji, Imamura Hirotoshi, Matsumaru Yuji, Sakai Chiaki, Satow Tetsu, Yoshimura Shinichi, Sakai Nobuyuki
Kobe City Medical Center General Hospital, Kobe, Japan.
Hyogo Medical University, Nishinomiya, Japan.
Neuroradiology. 2025 Apr 14. doi: 10.1007/s00234-025-03610-4.
Endovascular treatment (EVT) for acute ischemic stroke (AIS) with mild symptoms (National Institute of Health Stroke Scale [NIHSS] score of ≤ 5) has a specific concern about early neurological deterioration (END) after the procedure, but its significance remains unclear. This study aims to examine the prognostic impact and characteristics of END in this patient population.
We conducted a post-hoc analysis of the Japan Registry of NeuroEndovascular Therapy 4, enrolling 13,479 patients who underwent EVT for AIS at 166 participating centers between 2015 and 2019. We included patients with AIS and NIHSS scores ≤ 5 and compared outcomes (modified Rankin Scale [mRS] score at 30 days) between patients with and without END after EVT. Multivariate logistic regression models were used to explore associations between END and outcomes and risk factors for END.
Of 503 patients analyzed, 66 (13%) developed END. Patients who developed END had a lower proportion of mRS scores of 0-2 at 30 days than the No-END group (17% vs. 80%, P < 0.0001), with an adjusted odds ratio (OR) of 0.04 (95% confidence interval [CI], 0.02-0.11). Mortality within 30 days was higher among patients with END (9.1% vs. 0.7%, P < 0.0001). A multivariable logistic regression model identified that factors associated with END included age ≥ 75 years (adjusted OR 3.67; 95% CI, 1.78-7.55), ASPECTS (adjusted OR 0.82; 95% CI, 0.69-0.97), NIHSS scores before EVT of 0-2 compared with those of 3-5 (adjusted OR 2.11; 95% CI, 1.04-4.25), and unsuccessful recanalization (adjusted OR 8.39; 95% CI, 3.90-18.0).
END after EVT for AIS with mild symptoms was relatively common and associated with worse outcomes. Risk stratification for END and successful recanalization would be crucial, particularly for EVT candidates with mild symptoms.
对于症状轻微的急性缺血性卒中（AIS）（美国国立卫生研究院卒中量表[NIHSS]评分≤5）进行血管内治疗（EVT）时，术后早期神经功能恶化（END）是一个特别需要关注的问题，但其意义仍不明确。本研究旨在探讨END在该患者群体中的预后影响及特征。
我们对日本神经血管内治疗注册研究4进行了事后分析，纳入了2015年至2019年期间在166个参与中心接受AIS的EVT治疗的13479例患者。我们纳入了AIS且NIHSS评分≤5的患者，并比较了EVT术后发生END和未发生END的患者的结局（30天时的改良Rankin量表[mRS]评分）。使用多变量逻辑回归模型来探讨END与结局之间的关联以及END的危险因素。
在分析的503例患者中，66例（13%）发生了END。发生END的患者在30天时mRS评分为0 - 2的比例低于未发生END的组（17%对80%，P < 0.0001），调整后的优势比（OR）为0.04（95%置信区间[CI]，0.02 - 0.11）。发生END的患者30天内的死亡率更高（9.1%对0.7%，P < 0.0001）。多变量逻辑回归模型确定与END相关的因素包括年龄≥75岁（调整后的OR 3.67；95% CI，1.78 - 7.55）、脑缺血区域早期CT评分（ASPECTS）（调整后的OR 0.82；95% CI，0.69 - 0.97）、EVT术前NIHSS评分为0 - 2与3 - 5相比（调整后的OR 2.11；95% CI，1.04 - 4.25）以及再通失败（调整后的OR 8.39；95% CI，3.90 - 18.0）。
症状轻微的AIS患者接受EVT治疗后的END相对常见，且与更差的结局相关。对END和成功再通进行风险分层至关重要，特别是对于症状轻微的EVT候选患者。
