Early neurological changes following endovascular therapy for acute stroke due to intracranial atherosclerotic disease
- PMID: 38599028
- DOI: 10.1016/j.jns.2024.122978
Early neurological changes following endovascular therapy for acute stroke due to intracranial atherosclerotic disease
Abstract
Background: Endovascular therapy (EVT) reduces functional disability in patients with acute large vessel occlusion (LVO). However, the early neurological change after EVT may be limited in patients with intracranial atherosclerotic disease (ICAD).
Methods: We analyzed the Japanese Registry of NeuroEndovascular Therapy (JR-NET) 4 which was a retrospective, nationwide, multicenter registry of patients with LVO between 2015 and 2019. We compared the early neurological change, efficacy and safety of EVT for acute LVO in ICAD and other etiologies. The primary outcome was NIHSS improvement ≥10 points, and secondary outcome were NIHSS worsening ≥4 points 7 days after EVT, effective reperfusion rate, 30-day functional outcomes, and safety outcomes.
Results: Among the 6710 enrolled patients, 610 (9.1%) had ICAD. The ICAD group was younger (mean 72.0 vs. 75.8 years) and predominantly male (63.4% vs. 56.0%), had lower NIHSS scores before EVT (median 16 vs. 18), and underwent percutaneous transluminal angioplasty and stenting more frequently (43.0% vs. 4.4%, 12.3% vs. 4.4%). In the ICAD group, NIHSS improvement was significantly lower (adjusted odds ratio (aOR) [95% confidence interval (95%CI)] 0.52 [0.41-0.65]), NIHSS worsening was significantly higher (aOR [95%CI] 1.76 [1.31-2.34]), and effective reperfusion was significantly lower (aOR [95%CI] 0.47 [0.36-0.60]). Fewer patients with ICAD had modified Rankin scale 0-2 at 30 days (aOR [95%CI] 0.60 [0.47-0.77]). The risk of acute reocclusion was more prominent in the ICAD group (aOR [95%CI] 4.03 [1.98-8.21]).
Conclusions: Improvement in neurological severity after EVT was lower in patients with LVO and ICAD.
Keywords: Endovascular therapy; Intracranial atherosclerotic disease; Large vessel occlusion; NIHSS score.
Copyright © 2024 Elsevier B.V. All rights reserved.
Conflict of interest statement
Declaration of competing interest Dr. Uchida reports lecturer's fees from Daiichi Sankyo, Bristol-Myers Squibb, Stryker, and Medtronic. Dr. Yamagami discloses research grants from Bristol-Myers Squibb; lecturer's fees from Daiichi Sankyo, Stryker, Medtronic, Johnson & Johnson, and Medico's Hirata. Dr. Sakai N reports a research grant from Biomedical Solutions, Medtronic, Terumo and TG Medical; lecturer's fees from Asahi-Intec, Biomedical Solutions, Daiichi-Sankyo, Kaneka, Medtronic, and Terumo; membership on the advisory boards for Johnson&Johnson, Medtronic and Terumo outside the submitted work. Dr. Iiharai reports a research grant from Idorsia Pharamaceutical Japan outside the submitted work. Dr. Imamura reports the lecturer's fees from Medtronic, Daiichi Sankyo, Stryker, Johnson & Johnson, Terumo, and Asahi Intecc. Dr. Ishii received a reserach grant from Fuji Film and lecture fees from Medtronic, Stryker, Terumo and Johnson and Johnson. Dr. Matsumaru discloses lecturer fees from Medtronic, Stryker, Terumo, Kaneka, Biomedical solution, E.P. Medical, B Braun, Daiichi Sankyo and Idorcia outside the submitted work. Dr. Chiaki Sakai reports no conflict of interest. Dr. Satow reports research grants from CANON medical systems, lecturer's fees from Medtronic, and consulting fees from Kaneka Medix. Dr. Sakakibara reports a manuscript fee from Medicus Shuppan. Dr. Shirakawa reports lecturer's fees from Stryker, Terumo, Johnson & Johnson and Medtronic. Dr. Yoshimura reports research grants from Medico's Hirata, Medtronic, and Terumo; and lecturer fees from Medtronic, Kaneka, Stryker, Daiichi Sankyo, Bristol-Meyers Squibb, and Johnson & Johnson.
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