Thrombectomy patients with minor stroke: factors of early neurological deterioration

Background A sizeable proportion of stroke patients with large vessel occlusion present with minor neurological deficits. Whether mechanical thrombectomy (MT) is beneficial in these patients is controversial. We aimed to investigate factors of early neurological deterioration (END) in thrombectomy patients with minor stroke and hypothesized that END is linked to unfavorable functional outcomes. Methods Multicenter cohort study screening all patients prospectively enrolled in the German Stroke Registry–Endovascular Treatment (n=13 082) between 2015 and 2021. Patients who underwent MT for anterior circulation vessel occlusion with baseline National Institutes of Health Stroke Scale (NIHSS) score of <6 were included. END was defined as an increase in NIHSS score of ≥4 within the first 24 hours after MT. Multivariable regression analyses were performed to investigate factors associated with END and its association with unfavorable functional outcomes 90 days after treatment (modified Rankin Scale (mRS) score ≥2). Results Among 817 patients included, 24% exhibited END and 48% had unfavorable functional outcomes. Prestroke mRS (adjusted odds ratio (aOR) 95% CI 1.42 1.13 to 1.78), baseline NIHSS (aOR 95% CI 0.83 0.73 to 0.94), time from admission to groin puncture (aOR 95% CI 1.04 1.02 to 1.07), general anesthesia (aOR 95% CI 1.68 1.08 to 2.63), number of passes (aOR 95% CI 1.15 1.03 to 1.29), adverse events during treatment (aOR 95% CI 1.89 1.19 to 3.01), successful recanalization (aOR 95% CI 0.29 0.17 to 0.50), and intracranial hemorrhage on follow-up imaging (aOR 95% CI 3.40 1.90 to 6.07) were independently associated with END. END was independently linked to unfavorable functional outcomes (aOR 95% CI 7.51 4.57 to 12.34). Conclusions Almost a quarter of thrombectomy patients with minor stroke developed END. These patients had twice the odds of experiencing unfavorable functional outcomes.