- Among patients with acute minor stroke and large vessel occlusion (LVO), a score based on occlusion features accurately predicts early neurological deterioration of presumed ischemic origin (ENDi) after intravenous (IV) thrombolysis.
Why this matters
- Reliable risk prediction may support selection of patients for immediate transfer for additional thrombectomy.
- 12.1% of patients in the derivation cohort experienced ENDi.
- ENDi conferred poorer 3-month outcomes, even after rescue thrombectomy.
- Independent predictors of ENDi:
- More proximal occlusion site (P<.001>
- Longer thrombus (P=.002).
- 0.76 in the derivation cohort.
- 0.78 in the validation cohort.
- 0: ~3%.
- 1: 7%.
- 2: 20%.
- 3-4: 35%.
- Retrospective cohort study, France:
- Derivation cohort: 729 consecutive patients with minor stroke (National Institutes of Health Stroke Scale [NIHSS] score ≤5) and LVO who underwent IV thrombolysis alone at 45 centers.
- Validation cohort: 347 similar patients at 9 other centers.
- Main outcome: ENDi (≥4-point deterioration on NIHSS score within 24 hours, without parenchymal hemorrhage or other identified cause).
- Funding: None disclosed.
- Patients treated with bridging therapy were excluded.
- Lack of information on clinical fluctuations before admission, on hospital arrival.