Effectiveness and safety of EVT in patients with acute LVO and low NIHSSopen access
- Authors
- Kim, Beom Joon; Menon, Bijoy K.; Yoo, Joonsang; Han, Jung Hoon; Kim, Bum Joon; Kim, Chi Kyung; Kim, Jae Guk; Kim, Joon-Tae; Park, Hyungjong; Baik, Sung Hyun; Han, Moon-Ku; Kang, Jihoon; Kim, Jun Yup; Lee, Keon-Joo; Park, Jong-Moo; Kang, Kyusik; Lee, Soo Joo; Cha, Jae-Kwan; Kim, Dae-Hyun; Jeong, Jin-Heon; Park, Tai Hwan; Park, Sang-Soon; Lee, Kyung Bok; Lee, Jun; Hong, Keun-Sik; Cho, Yong-Jin; Park, Hong-Kyun; Lee, Byung-Chul; Yu, Kyung-Ho; Oh, Mi-Sun; Kim, Dong-Eog; Ryu, Wi-Sun; Choi, Kang-Ho; Choi, Jay Chol; Kim, Joong-Goo; Kwon, Jee-Hyun; Kim, Wook-Joo; Shin, Dong-Ick; Yum, Kyu Sun; Sohn, Sung-Il; Hong, Jeong-Ho; Kim, Chulho; Lee, Sang-Hwa; Lee, Juneyoung; Almekhlafi, Mohammed A.; Demchuk, Andrew; Bae, Hee-Joon
- Issue Date
- Aug-2022
- Publisher
- Frontiers Media S.A.
- Keywords
- endovascular recanalization; mild stroke; low NIHSS score; early neurological deterioration; CRCS-K; multicenter registry
- Citation
- Frontiers in Neurology, v.13
- Indexed
- SCIE
SCOPUS
- Journal Title
- Frontiers in Neurology
- Volume
- 13
- URI
- https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/63805
- DOI
- 10.3389/fneur.2022.955725
- ISSN
- 1664-2295
- 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.
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Collections - 1. Basic Science > Department of Biostatistics > 1. Journal Articles
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