Frequency, management, and outcomes of early neurologic deterioration due to stroke progression or recurrence

Abstract

Objective: The frequency, management, and outcomes of early neurologic deteriora-tion (END) after ischemic stroke specifically due to stroke progression or stroke recurrence have not been well delineated. Materials and methods: In a multicenter, nationwide registry, data on END due to stroke progression or recurrence con-firmed by imaging were collected prospectively between January 2019 and July 2020. Patient characteristics, management strategies, and clinical outcomes were analyzed. Results: Among 14,828 consecutive ischemic stroke patients, 1717 (11.6%) experienced END, including 1221 (8.2%) with END due to stroke progression (SP) or stroke recurrence (SR). Active management after END was implemented in 64.2% of patients. Active management strategies included volume expansion (29.2%), change in antithrombotic regimen (26.1%), induced hypertension (8.6%), rescue reperfusion therapy (6.8%), intracranial pressure lowering with hyperosmo-lar agents (1.5%), bypass surgery (0.6%), and hypothermia (0.1%). Active manage-ment strategies that varied with patient features included volume expansion and induced hypertension, used more often in large artery atherosclerosis and small vessel occlusion, and rescue endovascular thrombectomy, more common in other (dissection), cardioembolism, and large artery atherosclerosis. Active management was associated with higher rates of freedom from disability (modified Rankin Scale, mRS, 0-1; 24.3% vs. 16.6%) and functional independence (mRS, 0-2; 41.6% vs. 27.7%) at 3 months. Conclusion: END specifically due to stroke progression or recur-rence occurs in 1 in 12 acute ischemic stroke patients. In this observational study, active management, undertaken in two-thirds of patients, was most often hemody-namic or antithrombotic and was associated with improved functional outcomes.