Predictors of delayed neurological improvement after successful recanalization of acute anterior circula-tion large vessel occlusion
Objective To determine the prevalence and predictors of delayed function improvement(DFI)after successful re-perfusion in patients with acute anterior circulation large vessel occlu-sion(ALVO).Methods From December 2017 to December 2021,patients with ALVO who received emergency vascular recanali-zation in the Department of Cerebrovascular Disease Treatment Cen-ter,Nanjing Brain Hospital Affiliated to Nanjing Medical University and Nanjing Drum Tower Hospital Group Suqian Hospital were retro-spectively collected.Early neurological improvement(EFI)was de-fined as an improvement of more than 4 points for patients with a Na-tional Institutes of Health Stroke Scale(NIHSS)score above 4 points after 24 hours of successful revascularization;or for patients with NIHSS score≤4,the NIHSS score decreased to 0 or 1 after 24 hours of vascular recanalization.We defined DFI as the patients with ALVO who did not experience early functional improvement despite complete recanalization after EVT and still achieved a 90-day modified Rankin Scale(mRS)score of 0-2.Variables with P＜0.1 in the univariate analysis were included in the multivariate logistic regression model to determine the independent influencing factors of DFI.Results According to the inclusion and exclusion criteria,347 patients with ALVO who received emergency vascular recanali-zation were analyzed.The average age of the study population was 65 years,62％were male,and the median NIHSS score was 16.Of 347 patients,185(53.3％)developed EFI.Patients in the EFI group had lower age(P=0.028)and baseline NIHSS score(P=0.007),as well as a lower incidence of symptomatic intracranial hemorrhage(P＜0.001)and lung infection(P=0.002)than patients in the non-EF1 group.Of 162 non-EFI patients,36(22.2％)developed DFI.Compared with the non-DFI group,patients in the DFI group had low-er age(P＜0.001)and baseline NIHSS score(P＜0.001),a lower incidence of atrial fibrillation(P=0.008)and symptomatic intracrani-al hemorrhage(P=0.003),and a higher proportion of smokers(P=0.035).Multivariate logistic regression analysis showed that age[odds ratio(OR)0.94,95％confidence interval(CI)0.89-0.98],baseline NIHSS score(OR 0.88,95％CI 0.81-0.96),collateral circu-lation(OR 8.33,95％CI 2.41-28.82),and symptomatic intracranial hemorrhage(OR 0.20,95％CI 0.04-0.93)were independent pre-dictors of DFI.Conclusion More than half of patients with ALVO undergoing vascular recanalization experienced EFI,meanwhile more than 20％of patients without EFI also experienced DFI.Age,baseline NIHSS score,collateral circulation,and symptomatic intra-cranial hemorrhage were critical for DFI.Future studies should pay attention to the above factors to strengthen the management of me-chanical thrombectomy for ALVO.
acute large vessel occlusionvascular recanalizationdelayed functional improvementearly function improvement
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