Factors associated with unfavorable outcome after anterior circulation stroke despite successful reperfusion and early neurological improvement

Background and PurposeSuccessful reperfusion during endovascular therapy (EVT) usually leads to early neurological improvement (ENI), yet some patients do not achieve good long-term outcome. The aim of this study was to investigate factors associated with unfavorable clinical outcome (UCO) despite ENI. MethodsThis was a retrospective single-center analysis of consecutive patients treated for anterior circulation large vessel occlusion who achieved successful reperfusion and ENI (at least 20% lower follow-up NIHSS compared to NIHSS on admission) between 01/2014 and 04/2019. The primary endpoint was unfavorable outcome (90-day mRS > 2 or mRS > pre-stroke mRS). Patients with favorable clinical outcome (FCO) and UCO despite ENI were compared in univariable regression analysis. ResultsSuccessful EVT (mTICI 2c-3) and ENI occurred in 396/549 (72.1 %) patients and unfavorable outcome despite ENI in 168/396 (42.2 %) patients. Factors associated with UCO were pre-stroke mRS (Odds ratio (OR) 3.13 95% confidence interval (CI) 2.53-3.96, p < 0.001), age (OR 1.09 CI 1.07-1.12, p < 0.001), baseline NIHSs (OR 1.09 CI 1.06-1.13, p < 0.001), female sex (OR 1.92 CI 1.28-2.89, p = 0.002), hypertension (OR 2.32 CI 1.37-4.03, p = 0.002), smoking (OR 0.48 CI 0.25-0.87, p = 0.019), history of previous stroke (OR 2.7 CI 1.61-4.59, p < 0.001), atrial fibrillation (OR 1.73 CI 1.16-2.6, p = 0.007), neutrophil-lymphocyte ratio (OR 1.05 CI 1.01 - 1.09, p = 0.014), as well as ASPECTS after EVT (OR 0.77 CI 0.68-0.86, p < 0.001), TAN score (OR 0.60 CI 0.46-0.78, p < 0.001) and Swieten score (OR 2.55 CI 1.87-3.54, p < 0.001). Several ASPECTS regions were associated with UCO despite ENI (insula, M1-M3 and M5). ConclusionsRelevant factors associated with UCO despite successful EVT and ENI were patient age, sex, pre-stroke mRS, hypertension, history of smoking, previous stroke, atrial fibrillation, neutrophil-lymphocyte ratio, TAN and Swieten Score as well as ASPECTS after EVT. The involvement of certain brain regions by ASPECTS segments were associated with UCO despite ENI after EVT.