Factors associated with early neurological deterioration in minor distal medium vessel acute ischemic stroke: A multinational multicenter study

Dhairya A. Lakhani; Hamza Adel Salim; Vivek Yedavalli; Basel Musmar; Fathi Milhem; Nimer Adeeb; Tobias D. Faizy; Motaz Daraghma; Kareem El Naamani; Nils Henninger; Sri Hari Sundararajan; Anna Luisa Kuhn; Jane Khalife; Sherief Ghozy; Luca Scarcia; Leonard L. L. Yeo; Benjamin Y. Q. Tan; Robert W. Regenhardt; Jeremy J. Heit; Nicole M. Cancelliere; Aymeric Rouchaud; Jens Fiehler; Sunil Sheth; Ajit S. Puri; Christian Dyzmann; Marco Colasurdo; Leonardo Renieri; Joao Pedro Filipe; Pablo Harker; Razvan Alexandru Radu; Mohamad Abdalkader; Piers Klein; Thomas R. Marotta; Julian Spears; Takahiro Ota; Ashkan Mowla; Pascal Jabbour; Arundhati Biswas; Frederic Clarencon; James E. Siegler; Thanh N. Nguyen; Ricardo Varela; Amanda Baker; Muhammed Amir Essibayi; David Altschul; Nestor R. Gonzalez; Markus A. Mohlenbruch; Vincent Costalat; Benjamin Gory; Christian Paul Stracke; Constantin Hecker; Gaultier Marnat; Hamza Shaikh; Christoph J. Griessenauer; David S. Liebeskind; Alessandro Pedicelli; Andrea M. Alexandre; Illario Tancredi; Erwah Kalsoum; Boris Lubicz; Aman B. Patel; Vitor Mendes Pereira; Max Wintermark; Adrien Guenego; Adam A. Dmytriw; for the MAD MT Investigators

doi:10.1177/17474930251381946

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Factors associated with early neurological deterioration in minor distal medium vessel acute ischemic stroke: A multinational multicenter study

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Factors associated with early neurological deterioration in minor distal medium vessel acute ischemic stroke: A multinational multicenter study

Dhairya A. Lakhani, Hamza Adel Salim, Vivek Yedavalli, Basel Musmar, Fathi Milhem, Nimer Adeeb, Tobias D. Faizy, Motaz Daraghma, Kareem El Naamani, Nils Henninger, …

International journal of stroke, p.17474930251381946

15/09/2025

DOI: https://doi.org/10.1177/17474930251381946

PMID: 40954523

Résumé

Cardiovascular System & Cardiology

Clinical Neurology

Life Sciences & Biomedicine

Neurosciences & Neurology

Peripheral Vascular Disease

Science & Technology

Background: Patients with acute ischemic stroke secondary to distal and medium vessel occlusion (AIS-DMVO) and minor strokes present a challenge in determining the most appropriate emergent treatment. Factors leading to early neurological deterioration (END) in this patient population are understudied, but END is known to result in poor functional outcomes. Therefore, we aimed to investigate the factors contributing to END in minor AIS-DMVO cases.Methods: We included patients with AIS-DMVO and minor strokes from 37 sites across North America, Asia, and Europe. Minor stroke was defined as a baseline National Institutes of Health Stroke Scale (NIHSS) score of <= 5. The primary outcome measure, END, was defined as a shift of >= 4 points in the NIHSS score at day one after treatment compared to baseline. Univariable and multivariable logistic regression analyses were performed to identify factors associated with END.Results: Among 559 consecutive patients with DMVO and minor strokes, END was reported in 68 patients. In multivariable analysis, mechanical thrombectomy (MT) was independently associated with higher odds of END (adjusted odds ratio [aOR] 2.37, 95% CI 1.12-5.02, p = 0.02), while intravenous thrombolysis (IVT) was associated with lower odds of END (aOR 0.46, 95% CI 0.26-0.81, p = 0.008). However, the association between MT and END was no longer statistically significant in the IPTW-adjusted analysis (OR 1.65, 95% CI 0.69-3.98, p = 0.26). Hypertension and antiplatelet use at baseline were also independently associated with END. Among MT-treated patients, successful and excellent recanalization and first-pass effect were protective against END.Conclusion: MT was associated with END in patients with minor AIS-DMVO, although this association was not significant after IPTW adjustment. IVT was independently associated with reduced risk of END. These findings support careful patient selection and further study in randomized trials.

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Titre: Factors associated with early neurological deterioration in minor distal medium vessel acute ischemic stroke: A multinational multicenter study
Créateurs - sans rôle: Dhairya A. Lakhani - West Virginia Univ, Rockefeller Neurosci Inst, Dept Neuroradiol, Morgantown, WV 26506 USA
Hamza Adel Salim - College Station Medical Center
Vivek Yedavalli - College Station Medical Center
Basel Musmar - Thomas Jefferson University
Fathi Milhem - Harvard Med Sch, Massachusetts Gen Hosp, Neuroendovascular Program, Boston, MA USA
Nimer Adeeb - Louisiana State University
Tobias D. Faizy - Univ Med Ctr Munster, Dept Radiol, Neuroendovascular Program, Munster, Germany
Motaz Daraghma - Thomas Jefferson Univ, Dept Neurosurg, Philadelphia, PA USA
Kareem El Naamani - Thomas Jefferson University
Nils Henninger - Univ Massachusetts, Chan Med Sch, Dept Neurol, Worcester, MA USA
Sri Hari Sundararajan - NJMS, Dept Endovascular Neurosurg & Neuroradiol, Newark, NJ USA
Anna Luisa Kuhn - College Station Medical Center
Jane Khalife
Sherief Ghozy - Mayo Clin, Dept Neurol Surg & Radiol, Rochester, MN USA
Luca Scarcia - Henri Mondor Hosp, Dept Neuropathol, Creteil, France
Leonard L. L. Yeo - Natl Univ Singapore, Yong Loo Lin Sch Med, Dept Med, Singapore, Singapore
Benjamin Y. Q. Tan - Natl Univ Singapore, Yong Loo Lin Sch Med, Dept Med, Singapore, Singapore
Robert W. Regenhardt - Harvard Med Sch, Massachusetts Gen Hosp, Neuroendovascular Program, Boston, MA USA
Jeremy J. Heit - College Station Medical Center
Nicole M. Cancelliere - University of Toronto
Aymeric Rouchaud - XLIM
Jens Fiehler - NJMS, Dept Endovascular Neurosurg & Neuroradiol, Newark, NJ USA
Sunil Sheth - UTHealth, McGovern Med Sch, Dept Neurol, Houston, TX USA
Ajit S. Puri - College Station Medical Center
Christian Dyzmann - Sana Kliniken, Neuroradiol Dept, Lubeck GmbH, Lubeck, Germany
Marco Colasurdo - University of Portland
Leonardo Renieri - Osped Careggi Firenze, Interventist Neurovasc, Florence, Italy
Joao Pedro Filipe - Ctr Hosp Univ Porto, Dept Diagnost & Intervent Neuroradiol, Porto, Portugal
Pablo Harker - University of Cincinnati
Razvan Alexandru Radu - Montpellier Univ Med Ctr, Gui Chauliac Hosp, Dept Neuroradiol, Montpellier, France
Mohamad Abdalkader - College Station Medical Center
Piers Klein - College Station Medical Center
Thomas R. Marotta - University of Toronto
Julian Spears - Univ Toronto, Sch Med, Neurointervent & Neuroanalyt Collaborat NAN C, Toronto Metropolitan, Toronto, ON, Canada
Takahiro Ota - Tokyo Metropolitan Tama Med Ctr, Dept Neurosurg, Tokyo, Japan
Ashkan Mowla - Univ Southern Calif USC, Keck Sch Med, Dept Neurol Surg, Div Stroke & Endovascular Neurosurg, Los Angeles, CA USA
Pascal Jabbour - Thomas Jefferson University
Arundhati Biswas - New York Medical College
Frederic Clarencon - Hop La Pitie Salpetriere, Dept Neuroradiol, Paris, France
James E. Siegler
Thanh N. Nguyen - Boston Med Ctr, Dept Radiol & Neurol, Boston, MA USA
Ricardo Varela - Ctr Hosp Univ Porto, Dept Neurol, Porto, Portugal
Amanda Baker - Albert Einstein College of Medicine
Muhammed Amir Essibayi - Albert Einstein College of Medicine
David Altschul - Albert Einstein College of Medicine
Nestor R. Gonzalez - College Station Medical Center
Markus A. Mohlenbruch - Universitatsklinikum Heidelberg, Sekt Vaskulare & Interventionelle Neuroradiol, Heidelberg, Germany
Vincent Costalat - Montpellier Univ Med Ctr, Gui Chauliac Hosp, Dept Neuroradiol, Montpellier, France
Benjamin Gory - Nancy Univ Hosp, Dept Intervent Neuroradiol, Nancy, France
Christian Paul Stracke - Univ Med Ctr Munster, Dept Radiol, Intervent Neuroradiol Sect, Munster, Germany
Constantin Hecker - Paracelsus Med Univ, Dept Neurol & Neurosurg, Christian Doppler Clin, Salzburg, Austria
Gaultier Marnat
Hamza Shaikh
Christoph J. Griessenauer - Paracelsus Med Univ, Dept Neurol & Neurosurg, Christian Doppler Clin, Salzburg, Austria
David S. Liebeskind - Univ Calif Los Angeles, UCLA Stroke Ctr, Los Angeles, CA USA
Alessandro Pedicelli - Fdn Policlin Univ A Gemelli IRCCS, UOSA Neuroradiol Interventist, Rome, Italy
Andrea M. Alexandre - Fdn Policlin Univ A Gemelli IRCCS, UOSA Neuroradiol Interventist, Rome, Italy
Illario Tancredi - Hop Civil Marie Curie, Dept Neurol, Charleroi, Belgium
Erwah Kalsoum - Henri Mondor Hosp, Dept Neuropathol, Creteil, France
Boris Lubicz - Erasme Univ Hosp, Dept Diagnost & Intervent Neuroradiol, Brussels, Belgium
Aman B. Patel - Harvard Med Sch, Massachusetts Gen Hosp, Neuroendovascular Program, Boston, MA USA
Vitor Mendes Pereira - University of Toronto
Max Wintermark - MD Anderson Med Ctr, Dept Neuroradiol, Houston, TX USA
Adrien Guenego - Erasme Univ Hosp, Dept Diagnost & Intervent Neuroradiol, Brussels, Belgium
Adam A. Dmytriw - Harvard Med Sch, Massachusetts Gen Hosp, Neuroendovascular Program, Boston, MA USA
for the MAD MT Investigators
Détails de publication: International journal of stroke, p.17474930251381946
Éditeur: Sage
Nombre de pages: 10
Note de subvention: 5U54GM104942-08 / National Institute of General Medical Sciences of the National Institutes of Health; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of General Medical Sciences (NIGMS)
Identifiants: 99163077509311
Unité académique: Institut de Génomique Fonctionnelle - IGF
Langue: English
Type de ressource: Journal article