Predictors of early neurological deterioration after endovascular thrombectomy for anterior cerebral large-vessel occlusion

Abstract Aim Endovascular thrombectomy (EVT) proves to be beneficial for acute ischemic stroke (AIS) due to large vessel occlusion (LVO). However, post-thrombectomy patients may experience early neurological deterioration (END) after treatment. We sought to determine the predictors of END following EVT among patients with LVO in the anterior circulation. Methods A single-center retrospective observational study was performed on patients who underwent thrombectomy between January 2020 and March 2024. Univariable and multivariable logistic regression was performed to determine independent predictors of END within 24 h post EVT which was defined as an increase of National Institutes of Health Stroke Scale (NIHSS) scores ≥ 4 points or death. Results In-hospital END occurred in 22 (29.3%) of 75 included patients. The more prevalent variables were ASPECT score < 6 (OR 3.42, p = 0.01), collateral CIS 0–1 (OR 3.40, p = 0.01), unsuccessful recanalization (mTICI 0-2a) (OR 4.33, p = 0.01), and intracranial hemorrhage (OR 2.85, p = 0.048). According to multivariable regression analysis, unsuccessful recanalization was identified as an independent predictor of END post-EVT (aOR 4.25, p = 0.04). Conclusions Unsuccessful recanalization is an independent predictor of END following EVT for LVO in the anterior circulation. Improving techniques to ensure successful recanalization may lead to favorable outcomes.