AUTHOR=Zhong Xi , Tong Xu , Sun Xuan , Gao Feng , Mo Dapeng , Wang Yilong , Miao Zhongrong 

TITLE=Early Neurological Deterioration Despite Recanalization in Basilar Artery Occlusion Treated by Endovascular Therapy

JOURNAL=Frontiers in Neurology

VOLUME=11

YEAR=2020

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2020.592003

DOI=10.3389/fneur.2020.592003

ISSN=1664-2295

ABSTRACT=<p><bold>Background:</bold> We aim to identify the risk factors of early neurological deterioration (END) despite successful recanalization and explore the association of END with 90-day outcomes in acute basilar artery occlusion (BAO) treated by endovascular therapy (EVT).</p><p><bold>Methods:</bold> A prospectively registered consecutive cohort of BAO patients with successful recanalization by EVT in a tertiary stroke center during a 6-year period was reviewed. END was defined as an National Institutes of Health Stroke Scale (NIHSS) score increase ≥4 points, or death, from baseline to 24 h after EVT. Multivariate logistic regression analysis was used to identify the risk factors of END. The 90-day outcomes between END and non-END groups were compared by Pearson's χ<sup>2</sup> test.</p><p><bold>Results:</bold> END was observed in 21 of 148 patients included in this study. Multivariate logistic regression analysis showed that patients with progressive or fluctuating symptoms had a higher risk of END than those with symptoms of acute attack (OR 5.52, 95% CI 1.73–17.63), and NIHSS score and puncture-to-recanalization time (PTR), as continuous variables, were also significantly associated with END. Using a generalized additive model with spline smoothing function, we observed a linear relationship between PTR (increased by 1 h) and END (OR 2.57, 95% CI 1.45–4.57), and a non-linear relationship between NIHSS score and END. Only when the NIHSS score was ≥23 points was it related to END (OR 0.7, 95% CI 0.6–0.9). In addition, patients with END had a lower proportion of 90-day favorable outcome (19.0 vs. 59.1%, <italic>p</italic> &lt; 0.01) and higher mortality (33.3 vs. 13.4%, <italic>p</italic> = 0.048) than those with non-END.</p><p><bold>Conclusion:</bold> Mode of stroke onset, NIHSS score, and PTR may help to identify BAO patients with a higher risk of END after EVT. Moreover, END may affect the 90-day outcomes of these patients.</p>