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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 
 FRONTIERS IN NEUROLOGY, Vol.13 : 955725, 2022-08 
Journal Title
Issue Date
CRCS-K ; early neurological deterioration ; endovascular recanalization ; low NIHSS score ; mild stroke ; multicenter registry
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.
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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
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