Hemodynamic predictors of early neurological deterioration and clinical outcome after endovascular treatment in large artery occlusion
Objective: Half of the patients with acute large artery occlusion (LAO) have poor outcomes after endovascular treatment (EVT). Early complications such as cerebral edema and symptomatic intracranial hemorrhage (sICH) can lead to early neurological deterioration (END), which correlates with hemodynam...
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| Language: | English |
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Elsevier
2024-02-01
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| Series: | Heliyon |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405844024007771 |
| _version_ | 1797304539709177856 |
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| author | Jie Xu Xin-Yi Chen Hui-Yuan Wang Ya-Fei Shang Pan-Pan Shen Sheng Zhang Shun-Yuan Guo Ming-Ming Tan Yu Geng |
| author_facet | Jie Xu Xin-Yi Chen Hui-Yuan Wang Ya-Fei Shang Pan-Pan Shen Sheng Zhang Shun-Yuan Guo Ming-Ming Tan Yu Geng |
| author_sort | Jie Xu |
| collection | DOAJ |
| description | Objective: Half of the patients with acute large artery occlusion (LAO) have poor outcomes after endovascular treatment (EVT). Early complications such as cerebral edema and symptomatic intracranial hemorrhage (sICH) can lead to early neurological deterioration (END), which correlates with hemodynamics. This study aimed to identify the hemodynamic predictors of END and outcomes in LAO patients after EVT. Methods: A total of 76 patients with anterior circulation LAO who underwent EVT and received transcranial Doppler (TCD) monitoring were included. Bilateral middle cerebral artery (MCA) blood flow velocities (BFVs) were measured repeatedly within 1 week. Mean flow velocities (MFV) and MFV index (ipsilateral MFV/contralateral MFV) were calculated. The primary outcome was the incidence of END within 72 h. The secondary outcome was the functional outcome at 90 days—a good outcome was defined as a modified Rankin scale (mRS) score of 0–2, while a poor outcome was defined as an mRS score of 3–6. Results: A total of 13 patients (17.1 %) experienced END within 72 h, including 5 (38.5 %) with cerebral edema, 5 (38.5 %) with sICH, and 3 (23.0 %) with infarct progression. Multivariable logistic regression analysis showed that a higher 24 h MFV index was independently associated with END (aOR 10.5; 95 % CI 2.28–48.30, p = 0.003) and a poor 90-day outcome (aOR 5.10; 95 % CI 1.38–18.78, p = 0.014). The area under the receiver operating characteristic (ROC) curve (AUC) of the 24 h MFV index for predicting END was 0.807 (95 % CI 0.700–0.915, p = 0.0005), the sensitivity was 84.6 %, and the specificity was 66.7 %. At the 1-week TCD follow-up, patients who had poor 90-day outcomes showed significantly higher 1-week iMFV [73.5 (58.4–99.0) vs. 57.7 (45.3–76.3), p = 0.004] and MFV index [1.24 (0.98–1.57) vs.1.0 (0.87–1.15) p = 0.007]. A persistent high MFV index (PHMI) was independently associated with a poor outcome (aOR 7.77, 95 % CI 1.81–33.3, p = 0.006). Conclusion: TCD monitoring within 24 h after EVT in LAO patients can help predict END, while dynamic follow-up within 1 week is valuable in predicting clinical outcomes. |
| first_indexed | 2024-03-08T00:11:55Z |
| format | Article |
| id | doaj.art-2fec42f2090e47c39dd89cf5f310e370 |
| institution | Directory Open Access Journal |
| issn | 2405-8440 |
| language | English |
| last_indexed | 2024-03-08T00:11:55Z |
| publishDate | 2024-02-01 |
| publisher | Elsevier |
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| series | Heliyon |
| spelling | doaj.art-2fec42f2090e47c39dd89cf5f310e3702024-02-17T06:38:33ZengElsevierHeliyon2405-84402024-02-01103e24746Hemodynamic predictors of early neurological deterioration and clinical outcome after endovascular treatment in large artery occlusionJie Xu0Xin-Yi Chen1Hui-Yuan Wang2Ya-Fei Shang3Pan-Pan Shen4Sheng Zhang5Shun-Yuan Guo6Ming-Ming Tan7Yu Geng8Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, China; The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, ChinaCenter for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, China; The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, ChinaCenter for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, China; School of Clinical Medicine, Graduate School, Bengbu Medical College, Bengbu, 233030, Anhui, ChinaCenter for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, China; School of Clinical Medicine, Graduate School, Bengbu Medical College, Bengbu, 233030, Anhui, ChinaCenter for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, China; The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, ChinaCenter for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, ChinaCenter for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, ChinaDepartment of Quality Management, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, ChinaCenter for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, China; Corresponding author. Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), No.158 Shangtang Road, Gongshu District, Hangzhou, 310014, Zhejiang, China.Objective: Half of the patients with acute large artery occlusion (LAO) have poor outcomes after endovascular treatment (EVT). Early complications such as cerebral edema and symptomatic intracranial hemorrhage (sICH) can lead to early neurological deterioration (END), which correlates with hemodynamics. This study aimed to identify the hemodynamic predictors of END and outcomes in LAO patients after EVT. Methods: A total of 76 patients with anterior circulation LAO who underwent EVT and received transcranial Doppler (TCD) monitoring were included. Bilateral middle cerebral artery (MCA) blood flow velocities (BFVs) were measured repeatedly within 1 week. Mean flow velocities (MFV) and MFV index (ipsilateral MFV/contralateral MFV) were calculated. The primary outcome was the incidence of END within 72 h. The secondary outcome was the functional outcome at 90 days—a good outcome was defined as a modified Rankin scale (mRS) score of 0–2, while a poor outcome was defined as an mRS score of 3–6. Results: A total of 13 patients (17.1 %) experienced END within 72 h, including 5 (38.5 %) with cerebral edema, 5 (38.5 %) with sICH, and 3 (23.0 %) with infarct progression. Multivariable logistic regression analysis showed that a higher 24 h MFV index was independently associated with END (aOR 10.5; 95 % CI 2.28–48.30, p = 0.003) and a poor 90-day outcome (aOR 5.10; 95 % CI 1.38–18.78, p = 0.014). The area under the receiver operating characteristic (ROC) curve (AUC) of the 24 h MFV index for predicting END was 0.807 (95 % CI 0.700–0.915, p = 0.0005), the sensitivity was 84.6 %, and the specificity was 66.7 %. At the 1-week TCD follow-up, patients who had poor 90-day outcomes showed significantly higher 1-week iMFV [73.5 (58.4–99.0) vs. 57.7 (45.3–76.3), p = 0.004] and MFV index [1.24 (0.98–1.57) vs.1.0 (0.87–1.15) p = 0.007]. A persistent high MFV index (PHMI) was independently associated with a poor outcome (aOR 7.77, 95 % CI 1.81–33.3, p = 0.006). Conclusion: TCD monitoring within 24 h after EVT in LAO patients can help predict END, while dynamic follow-up within 1 week is valuable in predicting clinical outcomes.http://www.sciencedirect.com/science/article/pii/S2405844024007771UltrasonographyDopplerTranscranialThrombectomyHemodynamicsIschemic stroke |
| spellingShingle | Jie Xu Xin-Yi Chen Hui-Yuan Wang Ya-Fei Shang Pan-Pan Shen Sheng Zhang Shun-Yuan Guo Ming-Ming Tan Yu Geng Hemodynamic predictors of early neurological deterioration and clinical outcome after endovascular treatment in large artery occlusion Heliyon Ultrasonography Doppler Transcranial Thrombectomy Hemodynamics Ischemic stroke |
| title | Hemodynamic predictors of early neurological deterioration and clinical outcome after endovascular treatment in large artery occlusion |
| title_full | Hemodynamic predictors of early neurological deterioration and clinical outcome after endovascular treatment in large artery occlusion |
| title_fullStr | Hemodynamic predictors of early neurological deterioration and clinical outcome after endovascular treatment in large artery occlusion |
| title_full_unstemmed | Hemodynamic predictors of early neurological deterioration and clinical outcome after endovascular treatment in large artery occlusion |
| title_short | Hemodynamic predictors of early neurological deterioration and clinical outcome after endovascular treatment in large artery occlusion |
| title_sort | hemodynamic predictors of early neurological deterioration and clinical outcome after endovascular treatment in large artery occlusion |
| topic | Ultrasonography Doppler Transcranial Thrombectomy Hemodynamics Ischemic stroke |
| url | http://www.sciencedirect.com/science/article/pii/S2405844024007771 |
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