The Reversibly Stunned Brain After Successful Endovascular Reperfusion in Acute Anterior Circulation Ischemic Stroke
Tolga D. Dittrich, MD
Talavera B, Gómez-Vicente B, Martínez-Galdámez M, López-Cancio E, García-Cabo C, Castellanos M, Roel A, Tejada-Meza H, Marta-Moreno J, Pérez-Lázaro C, et al. Delayed Neurological Improvement After Full Endovascular Reperfusion in Acute Anterior Circulation Ischemic Stroke. Stroke. 2021;52:2210-2217.
Endovascular thrombectomy (EVT) is an essential part of acute therapy for ischemic stroke due to large vessel occlusion. As early clinical improvement after successful reperfusion therapy is a reliable predictor of long-term independence, the absence of such clinical progress can discourage the treating stroke team. But does this necessarily mean that the long-term prognosis in such patients is unfavorable? This is one of the questions addressed by Talavera et al. in their paper.
A total of 628 patients with proximal occlusions of the anterior circulation, all of whom received successful EVT (i.e., mTICI 3), were included in the study. After EVT, 142 (22.6%) showed no early neurological improvement. However, 32 (22.5%) still had a favorable long-term outcome. In contrast, 323 (66.5%) of a total of 486 patients with early neurological improvement demonstrated a favorable long-term outcome. Baseline predictors of delayed neurological improvement were male sex (OR 6.4 [95% CI, 2.1-22.3] p=.002), lower baseline NIHSS score (OR 1.4 [95% CI, 1.2-1.5]. p=<.001) and treatment with rtPA (OR 9.1, [95% CI, 2.7-30.9], p=<.001).