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Volume 11
Issue 7
10.3390/diagnostics11071272
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Article

Course of Early Neurologic Symptom Severity after Endovascular Treatment of Anterior Circulation Large Vessel Occlusion Stroke: Association with Baseline Multiparametric CT Imaging and Clinical Parameters

by
Matthias Philipp Fabritius
1,*,
Teresa A. Wölfer
2,
Moriz Herzberg
3,4,
Steffen Tiedt
2,
Daniel Puhr-Westerheide
1,
Sergio Grosu
1,
Stefan Maurus
1,
Thomas Geyer
1,
Adrian Curta
1,
Lars Kellert
5,
Clemens Küpper
5,
Thomas Liebig
4,
Jens Ricke
1,
Konstantinos Dimitriadis
2,5,
Wolfgang G. Kunz
1,
Hanna Zimmermann
4,† and
Paul Reidler
1,†
1
Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
2
Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
3
Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
4
Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
5
Department of Neurology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Diagnostics 2021, 11(7), 1272; https://doi.org/10.3390/diagnostics11071272
Submission received: 16 June 2021 / Revised: 1 July 2021 / Accepted: 12 July 2021 / Published: 15 July 2021
(This article belongs to the Section Medical Imaging and Theranostics)
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Abstract

Background: Neurologic symptom severity and deterioration at 24 hours (h) predict long-term outcomes in patients with acute large vessel occlusion (LVO) stroke of the anterior circulation. We aimed to examine the association of baseline multiparametric CT imaging and clinical factors with the course of neurologic symptom severity in the first 24 h after endovascular treatment (EVT). Methods: Patients with LVO stroke of the anterior circulation were selected from a prospectively acquired consecutive cohort of patients who underwent multiparametric CT, including non-contrast CT, CT angiography and CT perfusion before EVT. The symptom severity was assessed on admission and after 24 h using the 42-point National Institutes of Health Stroke Scale (NIHSS). Clinical and imaging data were compared between patients with and without early neurological deterioration (END). END was defined as an increase in ≥4 points, and a significant clinical improvement as a decrease in ≥4 points, compared to NIHSS on admission. Multivariate regression analyses were used to determine independent associations of imaging and clinical parameters with NIHSS score increase or decrease in the first 24 h. Results: A total of 211 patients were included, of whom 38 (18.0%) had an END. END was significantly associated with occlusion of the internal carotid artery (odds ratio (OR), 4.25; 95% CI, 1.90–9.47) and the carotid T (OR, 6.34; 95% CI, 2.56–15.71), clot burden score (OR, 0.79; 95% CI, 0.68–0.92) and total ischemic volume (OR, 1.01; 95% CI, 1.00–1.01). In a comprehensive multivariate analysis model including periprocedural parameters and complications after EVT, carotid T occlusion remained independently associated with END, next to reperfusion status and intracranial hemorrhage. Favorable reperfusion status and small ischemic core volume were associated with clinical improvement after 24 h. Conclusions: The use of imaging parameters as a surrogate for early NIHSS progression in an acute LVO stroke after EVT reached limited performance with only carotid T occlusion as an independent predictor of END. Reperfusion status and early complications in terms of intracranial hemorrhage are critical factors that influence patient outcome in the acute stroke phase after EVT.
Keywords: stroke; large vessel occlusion; multiparametric CT; CT perfusion; CT angiography; NIHSS; EVT stroke; large vessel occlusion; multiparametric CT; CT perfusion; CT angiography; NIHSS; EVT

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MDPI and ACS Style

Fabritius, M.P.; Wölfer, T.A.; Herzberg, M.; Tiedt, S.; Puhr-Westerheide, D.; Grosu, S.; Maurus, S.; Geyer, T.; Curta, A.; Kellert, L.; et al. Course of Early Neurologic Symptom Severity after Endovascular Treatment of Anterior Circulation Large Vessel Occlusion Stroke: Association with Baseline Multiparametric CT Imaging and Clinical Parameters. Diagnostics 2021, 11, 1272. https://doi.org/10.3390/diagnostics11071272

AMA Style

Fabritius MP, Wölfer TA, Herzberg M, Tiedt S, Puhr-Westerheide D, Grosu S, Maurus S, Geyer T, Curta A, Kellert L, et al. Course of Early Neurologic Symptom Severity after Endovascular Treatment of Anterior Circulation Large Vessel Occlusion Stroke: Association with Baseline Multiparametric CT Imaging and Clinical Parameters. Diagnostics. 2021; 11(7):1272. https://doi.org/10.3390/diagnostics11071272

Chicago/Turabian Style

Fabritius, Matthias Philipp, Teresa A. Wölfer, Moriz Herzberg, Steffen Tiedt, Daniel Puhr-Westerheide, Sergio Grosu, Stefan Maurus, Thomas Geyer, Adrian Curta, Lars Kellert, and et al. 2021. "Course of Early Neurologic Symptom Severity after Endovascular Treatment of Anterior Circulation Large Vessel Occlusion Stroke: Association with Baseline Multiparametric CT Imaging and Clinical Parameters" Diagnostics 11, no. 7: 1272. https://doi.org/10.3390/diagnostics11071272

APA Style

Fabritius, M. P., Wölfer, T. A., Herzberg, M., Tiedt, S., Puhr-Westerheide, D., Grosu, S., Maurus, S., Geyer, T., Curta, A., Kellert, L., Küpper, C., Liebig, T., Ricke, J., Dimitriadis, K., Kunz, W. G., Zimmermann, H., & Reidler, P. (2021). Course of Early Neurologic Symptom Severity after Endovascular Treatment of Anterior Circulation Large Vessel Occlusion Stroke: Association with Baseline Multiparametric CT Imaging and Clinical Parameters. Diagnostics, 11(7), 1272. https://doi.org/10.3390/diagnostics11071272

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