Acute Neurological Deterioration in Large Vessel Occlusions and Mild Symptoms Managed Medically

• Published in: Stroke (1970) 2020-05, Vol.51 (5), p.1428-1434
• Main Authors: Saleem, Yasir, Nogueira, Raul G., Rodrigues, Gabriel M., Kim, Song, Sharashidze, Vera, Frankel, Michael, Al-Bayati, Alhamza, Bianchi, Nicolas, Haussen, Diogo C.
• Format: Article
• Language: English
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.119.027011

BACKGROUND AND PURPOSE—It is unclear which factors predict acute neurological deterioration in patients with large vessel occlusion and mild symptoms. We aim to evaluate the frequency, timing, and potential predictors of acute neurological deterioration ≥4 National Institutes of Health Stroke Scale (NIHSS) points in medically managed patients with large vessel occlusion and mild presentation. METHODS—Single-center retrospective study of patients with consecutive minor stroke (defined as NIHSS score of ≤5 on presentation) and large vessel occlusion from January 2014 to December 2017. Primary outcome was acute neurological deterioration ≥4 NIHSS points during the hospitalization. Secondary outcomes included ΔNIHSS (defined as discharge minus admission NIHSS score). RESULTS—Among 1133 patients with acute minor strokes, 122 (10.6%) had visible occlusions on computed tomography angiography/magnetic resonance angiography. Twenty-four (19.7%) patients had ≥4 points deterioration on NIHSS at a median of 3.6 (1–16) hours from arrival. No clinical or radiological predictors of acute neurological deterioration ≥4 NIHSS points were observed on multivariable analysis. Rescue endovascular thrombectomy was performed more often in the ones with acute neurological deterioration ≥4 NIHSS points compared with patients with no deterioration (54% versus 0%; P