TY - JOUR
T1 - Factors associated with early neurological deterioration in minor distal medium vessel acute ischemic stroke
T2 - A multinational multicenter study
AU - Lakhani, Dhairya A.
AU - Salim, Hamza Adel
AU - Yedavalli, Vivek
AU - Musmar, Basel
AU - Milhem, Fathi
AU - Adeeb, Nimer
AU - Faizy, Tobias D.
AU - Daraghma, Motaz
AU - El Naamani, Kareem
AU - Henninger, Nils
AU - Sundararajan, Sri Hari
AU - Kuhn, Anna Luisa
AU - Khalife, Jane
AU - Ghozy, Sherief
AU - Scarcia, Luca
AU - Yeo, Leonard L. L.
AU - Tan, Benjamin Y. Q.
AU - Regenhardt, Robert W.
AU - Heit, Jeremy J.
AU - Cancelliere, Nicole M.
AU - Rouchaud, Aymeric
AU - Fiehler, Jens
AU - Sheth, Sunil
AU - Puri, Ajit S.
AU - Dyzmann, Christian
AU - Colasurdo, Marco
AU - Renieri, Leonardo
AU - Filipe, Joao Pedro
AU - Harker, Pablo
AU - Radu, Razvan Alexandru
AU - Abdalkader, Mohamad
AU - Klein, Piers
AU - Marotta, Thomas R.
AU - Spears, Julian
AU - Ota, Takahiro
AU - Mowla, Ashkan
AU - Jabbour, Pascal
AU - Biswas, Arundhati
AU - Clarencon, Frederic
AU - Siegler, James E.
AU - Nguyen, Thanh N.
AU - Varela, Ricardo
AU - Baker, Amanda
AU - Essibayi, Muhammed Amir
AU - Altschul, David
AU - Gonzalez, Nestor R.
AU - Mohlenbruch, Markus A.
AU - Costalat, Vincent
AU - Hecker, Constantin
AU - Griessenauer, Christoph J.
AU - MAD MT Investigators
N1 - Hecker, Griessenauer: Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
PY - 2025/9/15
Y1 - 2025/9/15
N2 - Background: Patients with acute ischemic stroke secondary to distal and medium vessel occlusion (AIS-DMVO) and minor strokes present a challenge in determining the most appropriate emergent treatment. Factors leading to early neurological deterioration (END) in this patient population are understudied, but END is known to result in poor functional outcomes. Therefore, we aimed to investigate the factors contributing to END in minor AIS-DMVO cases.Methods: We included patients with AIS-DMVO and minor strokes from 37 sites across North America, Asia, and Europe. Minor stroke was defined as a baseline National Institutes of Health Stroke Scale (NIHSS) score of <= 5. The primary outcome measure, END, was defined as a shift of >= 4 points in the NIHSS score at day one after treatment compared to baseline. Univariable and multivariable logistic regression analyses were performed to identify factors associated with END.Results: Among 559 consecutive patients with DMVO and minor strokes, END was reported in 68 patients. In multivariable analysis, mechanical thrombectomy (MT) was independently associated with higher odds of END (adjusted odds ratio [aOR] 2.37, 95% CI 1.12-5.02, p = 0.02), while intravenous thrombolysis (IVT) was associated with lower odds of END (aOR 0.46, 95% CI 0.26-0.81, p = 0.008). However, the association between MT and END was no longer statistically significant in the IPTW-adjusted analysis (OR 1.65, 95% CI 0.69-3.98, p = 0.26). Hypertension and antiplatelet use at baseline were also independently associated with END. Among MT-treated patients, successful and excellent recanalization and first-pass effect were protective against END.Conclusion: MT was associated with END in patients with minor AIS-DMVO, although this association was not significant after IPTW adjustment. IVT was independently associated with reduced risk of END. These findings support careful patient selection and further study in randomized trials.
AB - Background: Patients with acute ischemic stroke secondary to distal and medium vessel occlusion (AIS-DMVO) and minor strokes present a challenge in determining the most appropriate emergent treatment. Factors leading to early neurological deterioration (END) in this patient population are understudied, but END is known to result in poor functional outcomes. Therefore, we aimed to investigate the factors contributing to END in minor AIS-DMVO cases.Methods: We included patients with AIS-DMVO and minor strokes from 37 sites across North America, Asia, and Europe. Minor stroke was defined as a baseline National Institutes of Health Stroke Scale (NIHSS) score of <= 5. The primary outcome measure, END, was defined as a shift of >= 4 points in the NIHSS score at day one after treatment compared to baseline. Univariable and multivariable logistic regression analyses were performed to identify factors associated with END.Results: Among 559 consecutive patients with DMVO and minor strokes, END was reported in 68 patients. In multivariable analysis, mechanical thrombectomy (MT) was independently associated with higher odds of END (adjusted odds ratio [aOR] 2.37, 95% CI 1.12-5.02, p = 0.02), while intravenous thrombolysis (IVT) was associated with lower odds of END (aOR 0.46, 95% CI 0.26-0.81, p = 0.008). However, the association between MT and END was no longer statistically significant in the IPTW-adjusted analysis (OR 1.65, 95% CI 0.69-3.98, p = 0.26). Hypertension and antiplatelet use at baseline were also independently associated with END. Among MT-treated patients, successful and excellent recanalization and first-pass effect were protective against END.Conclusion: MT was associated with END in patients with minor AIS-DMVO, although this association was not significant after IPTW adjustment. IVT was independently associated with reduced risk of END. These findings support careful patient selection and further study in randomized trials.
KW - Dmvo
KW - Distal and medium vessel occlusion
KW - MeVO
KW - Acute ischemic stroke
KW - And early neurological deterioration
KW - Intravenous thrombolysis
KW - Mechanical thrombectomy
UR - https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=pmu_pure&SrcAuth=WosAPI&KeyUT=WOS:001598624800001&DestLinkType=FullRecord&DestApp=WOS_CPL
U2 - 10.1177/17474930251381946
DO - 10.1177/17474930251381946
M3 - Original Article
C2 - 40954523
SN - 1747-4930
JO - INTERNATIONAL JOURNAL OF STROKE
JF - INTERNATIONAL JOURNAL OF STROKE
ER -