Journal of stroke: What are the predictors of early neurological deterioration for minor strokes caused by blockage of large blood vessels?

Acute ischemic stroke patients with mild symptoms are common, accounting for about half of all patients
.

Although people consider minor strokes to be a benign disease, nearly one-third of patients have persistent disabilities

Stroke blood vessel

Whether endovascular therapy (EVT) is beneficial for minor strokes caused by LVO is uncertain, because most large EVT clinical trials have excluded patients with a National Institutes of Health Stroke Scale (NIHSS) score of 5 or less, and Some retrospective studies have reported conflicting results on the effects of EVT on minor strokes
.

Therefore, it is important to determine which patients are most likely to benefit from EVT with mild stroke and LVO
.

More than half of patients with mild stroke have shown good results within 3 months after treatment, and it seems that they are not suitable for EVT

At the same time, patients with neurological deterioration during the optimal medical treatment, even if they receive rescue EVT after clinical deterioration, the results are not as good as those who receive EVT immediately
.

Therefore, it is clinically important to identify patients who may have early neurological deterioration (END), because immediate EVT can be regarded as one of the treatment options for this patient group

Theoretically, the transition from oligemic tissue to a state of impaired function may lead to clinical deterioration
.

Based on this theory, tissues that have a larger area of ​​non-infarct but insufficient perfusion may have a greater risk of END

However, due to the heterogeneity of study participants in previous studies, whether these imaging variables can predict the END of LVO patients with mild symptoms is still unknown
.

Due to the heterogeneity of study participants in previous studies, it is still unknown whether these imaging variables can predict END in LVO patients with mild symptoms
.

Due to the heterogeneity of study participants in previous studies, it is still unknown whether these imaging variables can predict END in LVO patients with mild symptoms

They retrospectively analyzed 94 patients admitted to the hospital between January 2011 and May 2019, who saw a doctor within 24 hours after the onset of illness, with a baseline National Institutes of Health Stroke Scale score ≤5 and anterior circulation LVO
.

They used automated software programs to measure the ischemic core lesions identified on DWI and minimized manual editing
.

Perform dynamic susceptibility PWI and obtain the Tmax value of the residual function generated by deconvolution

Then, use the ROC curve to check the association of each variable with END
.

Finally, the variable with the best predictive performance is dichotomized at the cut-off point where the Youden index is maximized, and then analyzed using multivariate logistic regression

They found that: 39.
4% of the participants had END
.

The best variables were determined as Tmax>6 seconds, Tmax>6 seconds-DWI and Tmax 4-6 seconds, and the corresponding cut-off points were 53.
73, 32.
77, and 55.
20 mL, respectively
.

These variables are independently related to END, and the ORs corresponding to the above three predictors are 12.
78, 5.
73, and 9.
13 respectively.

The novelty of this study is the discovery: Tmax>6 seconds, Tmax>6 seconds-DWI and Tmax 4-6 seconds can identify high-risk patients after a minor stroke caused by LVO
.

Tmax>6 seconds, Tmax>6 seconds-DWI and Tmax 4-6 seconds can identify high-risk patients after a minor stroke caused by LVO
.
Tmax>6 seconds, Tmax>6 seconds-DWI and Tmax 4-6 seconds can identify high-risk patients after a minor stroke caused by LVO
.

 

Original Source:
Gwak DS, Kwon JA, Shim DH, Kim YW, Hwang YH.
Perfusion and Diffusion Variables Predict Early Neurological Deterioration in Minor Stroke and Large Vessel Occlusion.
J Stroke.
2021 Jan;23(1):61-68.
doi : 10.
5853/jos.
2020.
01466.
Epub 2021 Jan 31.
PMID: 33600703; PMCID: PMC7900396.

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