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August 22, 2025Open Access

Preoperative Neurological Changes on Outcomes in Large-Vessel Occlusion Due to Intracranial Atherosclerotic Disease

Key Points

Patients with symptom deterioration had significantly lower favorable outcomes after endovascular therapy compared to those with mild symptoms, emphasizing the importance of early detection.
Favorable outcomes were 38.2% for those with symptom deterioration versus 62.9% for mild symptoms, with adjusted odds ratios supporting better prognosis for milder cases.
The observational analysis included 480 patients with acute ischemic stroke, focusing on their neurological status transition before treatment.
Recognizing neurological deterioration in patients with intracranial atherosclerotic disease can potentially improve treatment outcomes.

Abstract

BACKGROUND AND OBJECTIVES: We aimed to clarify the association between neurological deterioration pre-endovascular therapy (EVT) and outcome in patients with large-vessel occlusion due to intracranial atherosclerotic disease (ICAD-LVO) undergoing EVT. METHODS: Consecutive patients with acute ischemic stroke due to ICAD-LVO within 24 h of onset who underwent EVT were enrolled in the Japanese multicenter registry from 2017 to 2019. Patients were grouped according to neurological severity transition as follows: mild symptoms (baseline National Institutes of Health Stroke Scale NIHSS score <6 and NIHSS score pre-EVT <6), symptom deterioration (baseline NIHSS score <6 and NIHSS score pre-EVT ≥6), and severe symptoms (baseline NIHSS score ≥6 and NIHSS score pre-EVT ≥6). Outcomes included favorable outcomes (modified Rankin Scale mRS score of 0-2 at 90 days), ordinal mRS shift, and symptomatic intracranial hemorrhage. Multivariable logistic regression assessed the association of outcomes with the transition of neurological severity by calculating odds ratios and 95% CIs, with mild symptoms as reference. RESULTS: In total, 480 patients with acute ICAD-LVO who underwent EVT (150 women 31.2%; median age, 72 years IQR, 66-80) and had median baseline NIHSS score 12 (IQR, 6-20) were analyzed. Patients with symptom deterioration (n = 34) and severe symptoms (n = 375) had lower favorable outcomes (deterioration 38.2% vs mild 62.9%; adjusted odds ratio 0.30, 95% CI 0.09-0.97, severe 35.3%; 0.47, 0.33-0.65) and a significant mRS shift (deterioration vs mild; 3.63, 1.46-9.03, severe; 2.27, 1.74-2.96) than those with mild symptoms (n = 71). Symptomatic intracranial hemorrhage rates did not differ (mild 0%; deterioration 0%; severe 1.9%). CONCLUSION: Patients with ICAD-LVO who experienced worsening symptoms were less likely to achieve favorable outcomes after EVT than those with mild symptoms. Early identification of neurological deterioration and EVT intervention may improve outcomes in these patients.

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