Early neurological deterioration following thrombolysis for minor stroke with isolated internal carotid artery occlusion. (14th October 2020)

• Record Type: Journal Article
• Authors: Boulenoir, N.; Turc, G.; Henon, H.; Laksiri, N.; Mounier‐Véhier, F.; Girard Buttaz, I.; Duong, D.‐L.; Papassin, J.; Yger, M.; Triquenot, A.; Lyoubi, A.; Ter Schiphorst, A.; Denier, C.; Baron, J.‐C.; Seners, P.
• Other Names: Ben Hassen Wagih investigator.; Lapergue Bertrand investigator.; Lamy Chantal investigator.; Lucas Ludovic investigator.; Philippeau Frédéric investigator.; Obadia Michael investigator.; Piotin Michel investigator.; Bennani Omar investigator.; Mechtouff Laura investigator.; Klapczynski Frédéric investigator.; Detante Olivier investigator.; Arquizan Caroline investigator.; Mione Gioia investigator.; Sablot Denis investigator.; Gazzola Sébastien investigator.; Debiais Séverine investigator.; Cakmak Serkan investigator.; Grigoras Valer investigator.; Tamazyan Ruben investigator.; Preterre Cécile investigator.; Rosso Charlotte investigator.; Niclot Philippe investigator.; Garnier Pierre investigator.; Soize Sébastien investigator.; Lun François investigator.; Tuffal Amélie investigator.; Boulanger Marion investigator.; Gazzola Sébastien investigator.; Zuber Mathieu investigator.; Pico Fernando investigator.; Clarençon Frédéric investigator.; Sibon Igor investigator.; Alamowitch Sonia investigator.; Fraticelli Laurie investigator.; Vallet Anne‐Evelyne investigator.; Costalat Vincent investigator.; Oppenheim Catherine investigator.; Cottier Jean‐Philippe investigator.; Berthezene Yves investigator.; Desal Hubert investigator.; Agius Pierre investigator.; Boutet Claire investigator.; Bricout Nicolas investigator.; Leys Didier investigator.; Chbicheb Mohamed investigator.; Malbranque Arnaud investigator.; Spelle Laurent investigator.; Bracard Serge investigator.; Masson Mylène investigator.;
• Is Part Of: European journal of neurology. Volume 28:Number 2(2021)
• Page Start: 479
• Page End: 490
• Publication Date: 2020-10-14
• Subjects: cerebral ischemia -- thrombolysis -- thrombectomy; Neurology -- Periodicals; Nervous system -- Diseases -- Periodicals; 616.8
• DOI: 10.1111/ene.14541
• Languages: English
• ISSNs: 1351-5101

Abstract

Abstract : Background and purpose: Better understanding the incidence, predictors and mechanisms of early neurological deterioration (END) following intravenous thrombolysis (IVT) for acute stroke with mild symptoms and isolated internal carotid artery occlusion (iICAo) may inform therapeutic decisions. Methods: From a multicenter retrospective database, we extracted all patients with both National Institutes of Health Stroke Scale (NIHSS) score <6 and iICAo (i.e. not involving the Willis circle) on admission imaging, intended for IVT alone. END was defined as ≥4 NIHSS points increase within 24 h. END and no‐END patients were compared for (i) pre‐treatment clinical and imaging variables and (ii) occurrence of intracranial occlusion, carotid recanalization and parenchymal hemorrhage on follow‐up imaging. Results: Seventy‐four patients were included, amongst whom 22 (30%) patients experienced END. Amongst pre‐treatment variables, suprabulbar carotid occlusion was the only admission predictor of END following stepwise variable selection (odds ratio = 4.0, 95% confidence interval: 1.3–12.2; P = 0.015). On follow‐up imaging, there was no instance of parenchymal hemorrhage, but an intracranial occlusion was now present in 76% vs. 0% of END and no‐END patients, respectively ( P < 0.001), and there was a trend toward higher carotid recanalization rate in END patients (29% vs. 9%, P = 0.07). As compared to no‐END, END was strongly associated with a poor 3‐month outcome. Conclusions: Early neurological deterioration is a frequent and highly deleterious event after IVT for minor stroke with iICAo, and is of thromboembolic origin in three out of four patients. The strong association with iICAo site—largely a function of underlying stroke etiology—may point to a different response of the thrombus to IVT. These findings suggest END may be preventable in this setting. Abstract : In this multicentre observational study including 74 patients with isolated internal carotid artery occlusion (i.e. without associated intracranial occlusion) with minor baseline symptoms (NIHSS score <6) and treated with IV‐thrombolysis, Early Neurological Deterioration (END) within 24hrs occurred in 30% of patients and was strongly associated with poor 3‐month outcome. The predominant END mechanism was thrombo‐embolic, as evidenced by a new intracranial occlusion in 3 out of 4 END cases. Supra‐bulbar carotid occlusion site –largely a function of underlying stroke etiology– was the only predictor of END, which may point to a different response of the thrombus to IV‐thrombolysis.