Endovascular therapy for early neurological deterioration in patients with minor stroke due to anterior circulation large vessel occlusion: comparison with medical treatment
10.3760/cma.j.issn.1673-4165.2025.07.002
- VernacularTitle:前循环大血管闭塞性轻型卒中患者早期神经功能恶化的血管内治疗：与药物治疗比较
- Author:
Zhonglun CHEN
1
;
Zhaokun LI
;
Mingjun PU
;
Shanshan ZHANG
;
Xianwen ZHANG
;
Xiaochen GONG
;
Yufeng TANG
Author Information
1. 绵阳市中心医院神经内科，绵阳 621000
- Keywords:
Ischemic stroke;
Severity of illness index;
Disease progression;
Endovascular procedures;
Thrombectomy;
Treatment outcome
- From:
International Journal of Cerebrovascular Diseases
2025;33(7):508-514
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the efficacy and safety of endovascular therapy (EVT) for early neurological deterioration (END) in patients with minor stroke due to acute anterior circulation large vessel occlusion.Methods:Consecutive patients with mild stroke due to acute anterior circulation large vessel occlusion admitted to Mianyang Central Hospital from October 2015 to October 2023 were included retrospectively. Minor stroke was defined as a baseline National Institutes of Health Stroke Scale (NIHSS) score <6. END was defined as an increase of ≥4 in NIHSS score compared to baseline within 12 hours of onset. According to whether EVT was performed or not, they were divided into EVT group and standard medical treatment (SMT) group. At 90 days after onset, the modified Rankin Scale was used to evaluate the outcome. 0-1 was defined as excellent outcome (primary outcome measure) and 0-2 was defined as good outcome (secondary outcome measure). The safety endpoints included symptomatic intracranial hemorrhage (sICH) within 72 hours after EVT and all-cause mortality within 90 days. Multivariate logistic regression analysis was used to determine the correlation between EVT and clinical outcome. Results:A total of 164 patients with minor stroke due to acute anterior circulation large vessel occlusion were included. Eighty-four patients (51.2%) developed END, of which 52 (61.9%) underwent EVT and 32 (38.1%) received SMT; 60 patients (71.4%) had excellent outcome, and 64 (76.2%) had good outcome. There was no significant difference in demographic and baseline clinical data between the EVT group and the SMT group. The excellent outcome rate of the EVT group at 90 days after onset showed a trend higher than that of SMT group (78.8% vs. 59.4%; χ2=3.680, P=0.055), but there was no significant difference in the good outcome rate and safety endpoints between the two groups. Multivariate logistic regression analysis showed that after adjusting for confounding factors, EVT was significantly and independently associated with excellent outcome at 90 days (odds ratio 4.955, 95% confidence interval 1.331-22.284; P=0.024). Conclusion:For patients with minor stroke due to anterior circulation large vessel occlusion who experience END, EVT may improve their functional outcome without increasing the risk of sICH and mortality.
