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

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Author(s)
Joon-Tae KimJi Sung LeeBeom Joon KimJong-Moo ParkKyusik KangSoo Joo LeeJae Guk KimJae-Kwan ChaDae-Hyun KimTai Hwan ParkKyung Bok LeeJun LeeKeun-Sik HongYong-Jin ChoHong-Kyun ParkByung-Chul LeeKyung-Ho YuMi Sun OhDong-Eog KimWi-Sun RyuJay Chol ChoiJee-Hyun KwonWook-Joo KimDong-Ick ShinKyu Sun YumSung Il SohnJeong-Ho HongSang-Hwa LeeMan-Seok ParkKang-Ho ChoiJuneyoung LeeJeffrey L SaverHee-Joon Bae
Keimyung Author(s)
Sohn, Sung Il
Department
Dept. of Neurology (신경과학)
Journal Title
J Stroke Cerebrovasc Dis
Issued Date
2023
Volume
32
Issue
2
Keyword
Acute ischemic strokeEND managementEarly neurologic deteriorationStroke progressionStroke recurrence
Abstract
Objective:
The frequency, management, and outcomes of early neurologic deterioration (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 confirmed 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 hyperosmolar agents (1.5%), bypass surgery (0.6%), and hypothermia (0.1%). Active management 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 recurrence occurs in 1 in 12 acute ischemic stroke patients. In this observational study, active management, undertaken in two-thirds of patients, was most often hemodynamic or antithrombotic and was associated with improved functional outcomes.
Keimyung Author(s)(Kor)
손성일
Publisher
School of Medicine (의과대학)
Type
Article
ISSN
1532-8511
Source
https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S1052305722006322?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1052305722006322%3Fshowall%3Dtrue&referrer=https:%2F%2Fpubmed.ncbi.nlm.nih.gov%2F
DOI
10.1016/j.jstrokecerebrovasdis.2022.106940
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/44767
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Neurology (신경과학)
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