Abstract WP6: Predictors of Acute Neurological Worsening in Ischemic Stroke After Endovascular Thrombectomy

Background: EVT is effective in AIS with LVO. Successful reperfusion is an integral factor that correlates strongly with good outcome. However, radiographic reperfusion does not always translate into good clinical outcomes. Reasons for poor outcome are thought to be multiple, such as progression of the stroke, and procedural complications - hemorrhagic conversion, vessel dissection, distal emboli, re-occlusion. Data on patients doing poorly in acute phase after EVT is limited. Objective: We studied the predictors of neurological worsening after EVT. Methods: Retrospective cohort from a single center. AIS patients with LVO in anterior/posterior circulation presented between December 2014 and May 2017 and received EVT. Primary outcome was 1) neurological worsening as change in NIHSS >4 from baseline after EVT in first 24 hours. 2) no improvement in NIHSS post EVT. Univariate and multivariate analysis evaluated clinical and radiographic variables independently correlating with neurological worsening after EVT. Results: 181 patients included, 21 (11.6%) met the criteria of neurological worsening. Mean age 61 (26-89), Baseline NIHSS 19 (5-35), ASPECT 7 (4-10), Systolic Blood Pressure (SBP) 152 (94-287), Blood Glucose 141 (69-433). The most common causes for worsening were progression of the stroke (38%) and reperfusion injury PH-2 (33%). Using univariate analysis DM (OR 5.21 CI 2.0 to 13.5; p 0.001), hyperlipidemia (HLD) (OR 4.99 CI 1.83 to 13.62; p 0.007), BG (OR 1.008 CI 1.0 to 1.15 p 0.009), SBP (OR 1.01 CI 1.0 to 1.0; p 0.04) were predictors of neurological worsening. In multivariate analysis, only HLD (OR 3.93 CI 1.3 to 11.7 p 0.01) was independent predictor. While admission BG, SBP, NIHSS showed trend towards statistical significance. Strong association between neurological worsening and poor outcome at discharge (MRS 4-6), p Conclusion: Our results are limited by small sample size. It showed that admission BP >150, BG, history of DM and HLD correlated with neurological worsening after EVT. HLD was an independent predictor. This puts emphasis on the importance to control these modifiable factors in EVT treated LVO patients. This also helps us identify which patients might worsen after EVT and how we can optimize this treatment.