Early neurological deterioration after endovascular treatment in acute ischemic stroke with large vessel occlusion

This study aimed to explore the occurrence, identify independent predictors, and assess the clinical implications of END following EVT in individuals with acute LVO. Participants were enrolled from the ANGEL-ACT registry. END was characterized by a rise of ≥ 4 points in the National Institutes of Health Stroke Scale (NIHSS) score from baseline to 24 h post-EVT. We conducted logistic regression analyses to pinpoint independent predictors of END. Among the 1557 patients included in the study, the occurrence of END stood at 9.8%. Factors independently associated with END included an admission NIHSS (adjusted odds ratio (aOR) = 4.067, 95% CI 2.513 to 6.582, p < 0.0001), an admission neutrophil-to-lymphocyte ratio (NLR) exceeding 5 (aOR = 1.811, 95% CI 1.246 to 2.632, p = 0.0018), the use of general anesthesia (GA) (aOR = 0.474, 95% CI 0.330 to 0.682, p < 0.0001), longer procedure duration (aOR = 5.500, 95% CI 1.45 to 20.871, p = 0.0122), and more than three retrieval attempts (aOR = 1.294, 95% CI 1.177 to 1.422, p < 0.0001). END manifested in 9.8% of patients undergoing endovascular therapy (EVT) for acute large vessel occlusion (LVO). This investigation highlights various independent predictors of END, providing valuable insights for daily clinical practice aimed at enhancing the effectiveness of intravascular thrombectomy. URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03370939; registration date: 11th November 2017.