Prognostic Accuracy of N20 Somatosensory Potential in Patients With Acute Ischemic Stroke and Endovascular Thrombectomy
Background Somatosensory evoked potentials may add substantial prognostic value in patients with acute ischemic stroke and contribute to the selection of patients who may benefit from revascularization therapies beyond the accepted therapeutic time windows. We aimed to study the prognostic accuracy...
| Main Authors: | , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-09-01
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| Series: | Stroke: Vascular and Interventional Neurology |
| Online Access: | https://www.ahajournals.org/doi/10.1161/SVIN.122.000735 |
| _version_ | 1827395193430605824 |
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| author | Alicia Martinez‐Piñeiro Giuseppe Lucente María Hernandez‐Perez Jordi Cortés Andrea Arbex Natalia Pérez de la Ossa Alba Ramos‐Fransí Miriam Almendrote Mònica Millán Meritxell Gomis Laura Dorado Carlos Castaño Sebastián Remollo Patricia Cuadras Alicia Garrido Nicolau Guanyabens Joaquim Broto Elena López‐Cancio Jaume Coll‐Canti Antoni Dávalos |
| author_facet | Alicia Martinez‐Piñeiro Giuseppe Lucente María Hernandez‐Perez Jordi Cortés Andrea Arbex Natalia Pérez de la Ossa Alba Ramos‐Fransí Miriam Almendrote Mònica Millán Meritxell Gomis Laura Dorado Carlos Castaño Sebastián Remollo Patricia Cuadras Alicia Garrido Nicolau Guanyabens Joaquim Broto Elena López‐Cancio Jaume Coll‐Canti Antoni Dávalos |
| author_sort | Alicia Martinez‐Piñeiro |
| collection | DOAJ |
| description | Background Somatosensory evoked potentials may add substantial prognostic value in patients with acute ischemic stroke and contribute to the selection of patients who may benefit from revascularization therapies beyond the accepted therapeutic time windows. We aimed to study the prognostic accuracy of the N20 somatosensory evoked potential component of the ischemic hemisphere in patients with anterior large‐vessel occlusion undergoing endovascular thrombectomy (EVT). Methods Presence and amplitude of the N20 response were recorded before and after EVT. Its adjusted predictive value for functional independence (modified Rankin scale score, ≤2) at day 7 was analyzed by binary logistic regression adjusting by age, mean arterial blood pressure, National Institute of Health Stroke Scale, Alberta Stroke Program Early CT Score, and serum glucose. N20 predictive power was compared with that of clinical and imaging models by using receiver operating characteristics curve analysis. Results A total of 223 consecutive patients were studied (mean age, 70 years; median National Institute of Health Stroke Scale score, 18). Somatosensory evoked potential recordings identified the presence of N20 in 110 (49.3%), absence in 58 (26%), and not assessable in 55 patients due to radiofrequency interferences in the angiography room. Before EVT, N20 predicted functional independence with a sensitivity of 93% (95% CI, 78%–98%) and negative predictive value of 93% (95% CI, 80%–98%). The adjusted odds ratio for functional independence was 9.9 (95% CI, 3.1–44.6). In receiver operating characteristics curve analysis, N20 amplitude showed a higher area under the curve than prehospital or in‐hospital variables, including advanced imaging. Sensitivity increased to 100% (95% CI, 0.85–1) when N20 was present after EVT. Conclusion Somatosensory evoked potential monitoring is a noninvasive and bedside technique that could help eligibility of patients with acute ischemic stroke for EVT and predict functional recovery. |
| first_indexed | 2024-03-08T18:28:48Z |
| format | Article |
| id | doaj.art-745d622dd8bb4445b305c23ab649aff7 |
| institution | Directory Open Access Journal |
| issn | 2694-5746 |
| language | English |
| last_indexed | 2024-03-08T18:28:48Z |
| publishDate | 2023-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Stroke: Vascular and Interventional Neurology |
| spelling | doaj.art-745d622dd8bb4445b305c23ab649aff72023-12-30T07:08:09ZengWileyStroke: Vascular and Interventional Neurology2694-57462023-09-013510.1161/SVIN.122.000735Prognostic Accuracy of N20 Somatosensory Potential in Patients With Acute Ischemic Stroke and Endovascular ThrombectomyAlicia Martinez‐Piñeiro0Giuseppe Lucente1María Hernandez‐Perez2Jordi Cortés3Andrea Arbex4Natalia Pérez de la Ossa5Alba Ramos‐Fransí6Miriam Almendrote7Mònica Millán8Meritxell Gomis9Laura Dorado10Carlos Castaño11Sebastián Remollo12Patricia Cuadras13Alicia Garrido14Nicolau Guanyabens15Joaquim Broto16Elena López‐Cancio17Jaume Coll‐Canti18Antoni Dávalos19Department of Neurology and Neurosciences Germans Trias i Pujol University Hospital Badalona SpainDepartment of Neurology and Neurosciences Germans Trias i Pujol University Hospital Badalona SpainDepartment of Neurology and Neurosciences Germans Trias i Pujol University Hospital Badalona SpainDepartment of Statistics and Operations Research Universitat Politècnica de Catalunya – BarcelonaTech (UPC) – Barcelona SpainDepartment of Neurology and Neurosciences Germans Trias i Pujol University Hospital Badalona SpainDepartment of Neurology and Neurosciences Germans Trias i Pujol University Hospital Badalona SpainDepartment of Neurology and Neurosciences Germans Trias i Pujol University Hospital Badalona SpainDepartment of Neurology and Neurosciences Germans Trias i Pujol University Hospital Badalona SpainDepartment of Neurology and Neurosciences Germans Trias i Pujol University Hospital Badalona SpainDepartment of Neurology and Neurosciences Germans Trias i Pujol University Hospital Badalona SpainDepartment of Neurology and Neurosciences Germans Trias i Pujol University Hospital Badalona SpainSection of Interventional Neurorradiology Department of Neurosciences Germans Trias i Pujol University Hospital Badalona SpainSection of Interventional Neurorradiology Department of Neurosciences Germans Trias i Pujol University Hospital Badalona SpainDepartment of Radiology Germans Trias i Pujol University Hospital Badalona SpainDepartment of Neurology Hospital Clinic Barcelona SpainDepatment of Neurology Hospital de Mataró, Mataró Barcelona SpainDepartment of Neurology Hospital Sagrat Cor Barcelona SpainDepartment of Neurology Hospital Universitario Central Asturias (HUCA) Instituto Investigación Sanitaria Principado de Asturias (ISPA) Oviedo SpainTime is Brain SL Germans Trias i Pujol Research Institute Badalona SpainDepartment of Neurology and Neurosciences Germans Trias i Pujol University Hospital Badalona SpainBackground Somatosensory evoked potentials may add substantial prognostic value in patients with acute ischemic stroke and contribute to the selection of patients who may benefit from revascularization therapies beyond the accepted therapeutic time windows. We aimed to study the prognostic accuracy of the N20 somatosensory evoked potential component of the ischemic hemisphere in patients with anterior large‐vessel occlusion undergoing endovascular thrombectomy (EVT). Methods Presence and amplitude of the N20 response were recorded before and after EVT. Its adjusted predictive value for functional independence (modified Rankin scale score, ≤2) at day 7 was analyzed by binary logistic regression adjusting by age, mean arterial blood pressure, National Institute of Health Stroke Scale, Alberta Stroke Program Early CT Score, and serum glucose. N20 predictive power was compared with that of clinical and imaging models by using receiver operating characteristics curve analysis. Results A total of 223 consecutive patients were studied (mean age, 70 years; median National Institute of Health Stroke Scale score, 18). Somatosensory evoked potential recordings identified the presence of N20 in 110 (49.3%), absence in 58 (26%), and not assessable in 55 patients due to radiofrequency interferences in the angiography room. Before EVT, N20 predicted functional independence with a sensitivity of 93% (95% CI, 78%–98%) and negative predictive value of 93% (95% CI, 80%–98%). The adjusted odds ratio for functional independence was 9.9 (95% CI, 3.1–44.6). In receiver operating characteristics curve analysis, N20 amplitude showed a higher area under the curve than prehospital or in‐hospital variables, including advanced imaging. Sensitivity increased to 100% (95% CI, 0.85–1) when N20 was present after EVT. Conclusion Somatosensory evoked potential monitoring is a noninvasive and bedside technique that could help eligibility of patients with acute ischemic stroke for EVT and predict functional recovery.https://www.ahajournals.org/doi/10.1161/SVIN.122.000735 |
| spellingShingle | Alicia Martinez‐Piñeiro Giuseppe Lucente María Hernandez‐Perez Jordi Cortés Andrea Arbex Natalia Pérez de la Ossa Alba Ramos‐Fransí Miriam Almendrote Mònica Millán Meritxell Gomis Laura Dorado Carlos Castaño Sebastián Remollo Patricia Cuadras Alicia Garrido Nicolau Guanyabens Joaquim Broto Elena López‐Cancio Jaume Coll‐Canti Antoni Dávalos Prognostic Accuracy of N20 Somatosensory Potential in Patients With Acute Ischemic Stroke and Endovascular Thrombectomy Stroke: Vascular and Interventional Neurology |
| title | Prognostic Accuracy of N20 Somatosensory Potential in Patients With Acute Ischemic Stroke and Endovascular Thrombectomy |
| title_full | Prognostic Accuracy of N20 Somatosensory Potential in Patients With Acute Ischemic Stroke and Endovascular Thrombectomy |
| title_fullStr | Prognostic Accuracy of N20 Somatosensory Potential in Patients With Acute Ischemic Stroke and Endovascular Thrombectomy |
| title_full_unstemmed | Prognostic Accuracy of N20 Somatosensory Potential in Patients With Acute Ischemic Stroke and Endovascular Thrombectomy |
| title_short | Prognostic Accuracy of N20 Somatosensory Potential in Patients With Acute Ischemic Stroke and Endovascular Thrombectomy |
| title_sort | prognostic accuracy of n20 somatosensory potential in patients with acute ischemic stroke and endovascular thrombectomy |
| url | https://www.ahajournals.org/doi/10.1161/SVIN.122.000735 |
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