Factors associated with early neurological deterioration in minor distal medium vessel acute ischemic stroke: A multinational multicenter study.
Publication/Presentation Date
3-1-2026
Abstract
BACKGROUND: Patients with acute ischemic stroke secondary to distal and medium vessel occlusion (AIS-DMVO) and minor strokes present a challenge in determining the most appropriate emergent treatment. Factors leading to early neurological deterioration (END) in this patient population are understudied, but END is known to result in poor functional outcomes. Therefore, we aimed to investigate the factors contributing to END in minor AIS-DMVO cases.
METHODS: We included patients with AIS-DMVO and minor strokes from 37 sites across North America, Asia, and Europe. Minor stroke was defined as a baseline National Institutes of Health Stroke Scale (NIHSS) score of ⩽5. The primary outcome measure, END, was defined as a shift of ⩾4 points in the NIHSS score at day one after treatment compared to baseline. Univariable and multivariable logistic regression analyses were performed to identify factors associated with END.
RESULTS: Among 559 consecutive patients with DMVO and minor strokes, END was reported in 68 patients. In multivariable analysis, mechanical thrombectomy (MT) was independently associated with higher odds of END (adjusted odds ratio [aOR] 2.37, 95% CI 1.12-5.02,
CONCLUSION: MT was associated with END in patients with minor AIS-DMVO, although this association was not significant after IPTW adjustment. IVT was independently associated with reduced risk of END. These findings support careful patient selection and further study in randomized trials.
Volume
21
Issue
3
First Page
343
Last Page
352
ISSN
1747-4949
Published In/Presented At
Lakhani, D. A., Salim, H. A., Yedavalli, V., Musmar, B., Milhem, F., Adeeb, N., Faizy, T. D., Daraghma, M., El Naamani, K., Henninger, N., Sundararajan, S. H., Kühn, A. L., Khalife, J., Ghozy, S., Scarcia, L., Yeo, L. L., Tan, B. Y., Regenhardt, R. W., Heit, J. J., Cancelliere, N. M., … MAD MT Investigators (2026). Factors associated with early neurological deterioration in minor distal medium vessel acute ischemic stroke: A multinational multicenter study. International journal of stroke : official journal of the International Stroke Society, 21(3), 343–352. https://doi.org/10.1177/17474930251381946
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
40954523
Department(s)
Administration and Leadership
Document Type
Article