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

Authors
 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 
Citation
 FRONTIERS IN NEUROLOGY, Vol.13 : 955725, 2022-08 
Journal Title
FRONTIERS IN NEUROLOGY
Issue Date
2022-08
Keywords
CRCS-K ; early neurological deterioration ; endovascular recanalization ; low NIHSS score ; mild stroke ; multicenter registry
Abstract
Background and purpose: There is much uncertainty in endovascular treatment (EVT) decisions in patients with acute large vessel occlusion (LVO) and mild neurological deficits.

Methods: From 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.

Results: Among 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]).

Conclusions: The 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.
Files in This Item:
T9992022818.pdf Download
DOI
10.3389/fneur.2022.955725
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
Yonsei Authors
Yoo, Joon Sang(유준상) ORCID logo https://orcid.org/0000-0003-1169-6798
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/193821
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