Abstract W P47: Recanalization After IV TPA Alone Among Acute Ischemic Stroke Patients Treated With Combined IV-Endovascular Recanalization: Impact of Arterial Occlusion Site

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Seo Hyun Kim ◽  
David Liebeskind ◽  
Reza Jahan ◽  
Sidney Starkman ◽  
Latisha Ali ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cerebral Artery ◽  
Endovascular Therapy ◽  
Multivariate Logistic Regression Analysis ◽  
Arterial Occlusion ◽  
High Rate ◽  
Large Artery ◽  
Diagnostic Catheter ◽  
Iv Tpa

Background: Combined IV TPA and catheter-based reperfusion is an emerging treatment strategy for acute ischemic stroke. Both patient care and clinical trial design would be enhanced by delineation of which patients rapidly respond to IV TPA alone, before endovascular therapy can be initiated. Methods: In a prospectively maintained registry of patients treated under a general policy of combined IV TPA and endovascular therapy, we analyzed subjects with MRA/CTA-confirmed anterior circulation occlusions prior to IV TPA start. Results: Among 118 patients meeting study entry criteria, age was mean 71.5 (SD 14.5), 53.0% were female, and baseline NIHSS was 14.4 (SD 7.1). Confirmed sites of occlusion prior to IV TPA were internal cerebral artery (ICA) in 22.9%, M1 segment of middle cerebral artery (MCA) in 50.0%, and M2-3 in 27.1%. Among patients undergoing catheter cerebral angiography, median time from start of IV TPA to diagnostic catheter angiogram was 75 mins (IQR 50-113). A total of 48 (40.7%) patients achieved partial or complete recanalization (AOL 2-3) of the initial target artery with IV TPA alone (partial in 22 (18.6%) and complete in 26 (22.2%)); an additional 44 (37.3%) achieved partial or complete recanalization after endovascular therapy. Recanalization rates after IV TPA alone varied by target occlusion site: ICA - 22.2%, M1 - 40.7%, and M2-3 - 56.2%. In multivariate logistic regression analysis, independent predictors of recanalization with IV TPA alone were: M2-3 clot location, OR 3.04 (95% CI 1.20-7.73, p=0.019) and TOAST etiology large-artery atherosclerosis, OR 0.14 (CI 0.04-0.50, p = 0.003). Good outcome (mRS ≤ 3) rates at 3 months were 76.6% among recanalizers with IV TPA alone and 47.5% among recanalizers after both IV TPA and catheter therapy. Conclusions: When combined IV-endovascular treatment is pursued, recanalization with IV TPA alone occurs in 4 out of 10 patients before catheter therapy is started, is more common with more distal clot location, and is associated with a high rate of excellent clinical outcomes.

scholarly journals In-hospital recurrence in a Chinese large cohort with acute ischemic stroke

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Fan Yu ◽  
Xiaolu Liu ◽  
Qiong Yang ◽  
Yu Fu ◽  
Dongsheng Fan
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Acute Ischemic Stroke ◽  
Recurrent Events ◽  
Early Stage ◽  
High Rate ◽  
Large Artery ◽  
Stroke Event

Abstract Acute ischemic stroke (AIS) has a high risk of recurrence, particularly in the early stage. The purpose of this study was to assess the frequency and risk factors of in-hospital recurrence in patients with AIS in China. A retrospective analysis was performed of all of the patients with new-onset AIS who were hospitalized in the past three years. Recurrence was defined as a new stroke event, with an interval between the primary and recurrent events greater than 24 hours; other potential causes of neurological deterioration were excluded. The risk factors for recurrence were analyzed using univariate and logistic regression analyses. A total of 1,021 patients were included in this study with a median length of stay of 14 days (interquartile range,11–18). In-hospital recurrence occurred in 58 cases (5.68%), primarily during the first five days of hospitalization. In-hospital recurrence significantly prolonged the hospital stay (P < 0.001), and the in-hospital mortality was also significantly increased (P = 0.006). The independent risk factors for in-hospital recurrence included large artery atherosclerosis, urinary or respiratory infection and abnormal blood glucose, whereas recurrence was less likely to occur in the patients with aphasia. Our study showed that the patients with AIS had a high rate of in-hospital recurrence, and the recurrence mainly occurred in the first five days of the hospital stay. In-hospital recurrence resulted in a prolonged hospital stay and a higher in-hospital mortality rate.

Abstract T P10: Therapeutic Time Window for Endovascular Therapy of Acute Ischemic Stroke Depends on THRIVE Score: A Retrospective Single-center Study

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Kenichi Todo ◽  
Nobuyuki Sakai ◽  
Tomoyuki Kono ◽  
Taku Hoshi ◽  
Hirotoshi Imamura ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Time Window ◽  
Medical Center ◽  
Multivariate Logistic Regression Analysis ◽  
Symptom Duration ◽  
Vascular Events ◽  
Good Outcome ◽  
Therapeutic Time Window

Background and purpose: The outcome after endovascular therapy in acute ischemic stroke is associated with onset-to-reperfusion time (ORT). The Totaled Health Risks in Vascular Events (THRIVE) score is also an important pre-thrapeutic predictor of outcome. We hypothesized that the therapeutic time window is narrower in patients with the higher THRIVE score. Methods: We retrospectively studied consecutive 109 ischemic stroke patients with successful reperfusion after endovascular therapy between October 2005 and March 2014 at a single institute (Kobe City Medical Center General Hospital). Inclusion criteria was as follows: National Institutes of Health Stroke Scale (NIHSS) score ≥8, stroke symptom duration ≤8 h, premorbid modified Rankin Scale (mRS) score ≤2, and thrombolysis myocardial infarction score 2-3. We analyzed the relationships of ORT, THRIVE score, and THRIVE+ORT score with good outcome (mRS ≤2 at 3 months). The THRIVE+ORT score was defined as the sum of the THRIVE score and ORT (h). Results: Median ORT was 5.5 h (IQR; 4.4-7.1 h), median THRIVE score was 5 (IQR; 4-6), and median THRIVE+ORT score was 10.8 (IQR; 9.2-12.5). Good outcome rates for patients with ORT ≤4 h, >4 and ≤6 h, >6 and ≤8 h, and >8h were 50.0%, 45.8%, 37.0%, and 21.4%, respectively (p=0.3), those with THRIVE score ≤3, >3 and ≤5, >5 and ≤7, and >7 were 57.1%, 51.4%, 28.3%, and 20.0%, respectively (p9 and ≤11, >11 and ≤13, and >13 were 64.0%, 44.1%, 34.4%, and 16.7%, respectively (p<0.05). Multivariate logistic regression analysis revealed that THRIVE+ORT score was an independent predictor of good outcome after adjusted for THRIVE score (odds ratio [OR], 1.367; 95% confidence interval [CI], 1.082-1.728) or after adjusted for ORT (OR, 1.517: 95% CI, 1.160-1.983). Conclusion: Our study showed that THRIVE+ORT score was associated with outcome that was independent from THRIVE score or ORT. This is the first report to suggest that patients with the higher THRIVE score require the shorter ORT for good outcome.

Abstract TMP89: Collaterals and Reperfusion Mediate Blood Pressure Changes in Acute Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
David S Liebeskind ◽  
Graham W Woolf ◽  
Nerses Sanossian ◽  
Jason D Hinman ◽  
Radoslav Raychev ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Arterial Occlusion ◽  
Patient Specific ◽  
Pressure Data ◽  
Blood Pressure Data ◽  
Pressure Changes ◽  
Continuous Blood Pressure

Background: The pathophysiology and optimal management of blood pressure changes in acute ischemic stroke remain unknown. Blood pressure guidelines do not consider patient-specific or serial data on dynamic blood pressure readings. We investigated continuous blood pressure data during endovascular therapy for acute stroke to discern changes associated with collaterals, recanalization and reperfusion. Methods: Continuous monitoring blood pressure data was collected in consecutive cases of endovascular therapy for acute ischemic stroke due to ICA or proximal MCA occlusion. Angiography details were independently analyzed to document site of arterial occlusion, baseline collateral grade, time of device deployments, time of recanalization, time of final reperfusion, final AOL recanalization and final TICI reperfusion. Statistical analyses correlated instantaneous and serial blood pressure changes with these angiographic parameters. Results: 80 patients (median age 73 years; 33 women) were studied. Arterial lesions included 37 ICA and 41 proximal M1 MCA occlusions. Collateral grade prior to intervention included 2 ASITN grade 4, 26 grade 3, 23 grade 2, 6 grade 1 and 0 grade 0. oTICI2C reperfusion scores after thrombectomy included 2 TICI 3 (100%), 22 TICI 2C (90-99%), 25 TICI o2B (67-89%), 9 TICI m2B (50-66%), 19 TICI 2A (<50%) and 3 TICI 0/1. More robust collateral grade was associated with greater reperfusion scores (r=0.32, p=0.028). The change in blood pressure (ΔBP) from earliest BP to time of recanalization was mean 59% of ΔBP during the entire procedure. Better collaterals were associated with lower BP prior to recanalization (r=-0.377, p=0.012). Lower BP prior to recanalization was linked with greater TICI reperfusion (r=-0.242, p=0.050). Higher TICI reperfusion scores were also associated with a greater drop or ΔBP at the time of recanalization (r=0.269, p=0.031). AOL recanalization was not related to ΔBP. Conclusions: Collaterals and reperfusion, but not recanalization, mediate blood pressure changes in acute ischemic stroke. Prospective, precision medicine stroke studies should leverage patient-specific, real-time data on continuous blood pressure with imaging correlates to define BP goals of future in-hospital management.

scholarly journals Endovascular Therapy for Acute Ischemic Stroke With Occlusion of the Middle Cerebral Artery M2 Segment

2016 ◽  
Vol 73 (11) ◽  
pp. 1291 ◽  
Author(s):  
Amrou Sarraj ◽  
Navdeep Sangha ◽  
Muhammad Shazam Hussain ◽  
Dolora Wisco ◽  
Nirav Vora ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Cerebral Artery ◽  
Endovascular Therapy

Distal versus Proximal Middle Cerebral Artery Occlusion: Different Mechanisms

2019 ◽  
Vol 47 (5-6) ◽  
pp. 238-244
Author(s):  
Young Seo Kim ◽  
Bum Joon Kim ◽  
Kyung Chul Noh ◽  
Kyung Mi Lee ◽  
Sung Hyuk Heo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Artery Occlusion ◽  
High Rate ◽  
Collateral Flow ◽  
Large Artery ◽  
Factors Associated ◽  
Imaging Characteristics ◽  
Distal Migration

Background: Clinical and radiological characteristics of middle cerebral artery (MCA) infarction may differ according to the location of occlusion. Objectives: We investigated the difference between proximal and distal symptomatic MCA occlusion (MCAO) in patients with ischemic stroke. The factors associated with the imaging characteristics were also analyzed. Methods: Patients with ischemic stroke due to MCAO were consecutively enrolled. The location of MCAO was determined by the ratio of the length of the ipsilesional MCA to that of the contralateral MCA and dichotomized to proximal and distal MCAO. Clinical and radiological characteristics were compared between patients with proximal and distal MCAO. Factors associated with the basal ganglia (BG) involvement, hemorrhagic transformation (HT), and neurological change during admission were investigated. Results: Among 181 included patients, MCAO location showed a bimodal peak (at the proximal [n = 99] and distal MCA [n = 82]). Proximal MCAO was more frequently associated with hyperlipidemia and large artery atherosclerosis, whereas distal MCAO was more frequently associated with hypertension, atrial fibrillation, and cardioembolic stroke. BG involvement was similar between the 2 groups (48 vs. 39%; p = 0.21), whereas HT was more frequent in distal MCAO (10 vs. 23%; p = 0.02). Among patients with proximal MCAO, hyperintense vessel sign was less frequently observed in those with a BG involvement than those without (38 vs. 60%; p = 0.03). Among those without BG involvement, the presence of HT was very low and similar between patients with proximal and distal MCAOs (1.9 vs. 2.0%). However, in patients with BG involvement, HT was more frequently observed in those with distal MCAO than in those with proximal MCAO (54.8 vs. 15.7%; p < 0.001). The presence of hyperintense vessel sign (OR 0.172, 95% CI 0.051–0.586; p = 0.005) and distal MCAO (OR 0.200, 95% CI 0.059–0.683; p = 0.011) was independently associated with improvement during admission. Conclusion: Proximal MCAO is more frequently associated with atherosclerosis, whereas distal MCAO is more frequently associated with cardioembolism. In proximal MCAO, the status of collateral flow presented by hyperintense vessel sign may affect the involvement of BG. In distal MCAO, distal migration of the embolus, which first impacted at the proximal MCA causing BG ischemia, may explain the high rate of HT by reperfusion injury. Hyperintense vessel sign and distal MCAO were independently associated with neurological improvement during admission.

Abstract WMP5: Predictors and Clinical Relevance of Hemorrhagic Transformation after Endovascular Therapy for Acute Ischemic Stroke: a Multicenter Retrospective Analysis of 1122 Patients

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Raul G Nogueira ◽  
Rishi Gupta ◽  
Tudor G Jovin ◽  
Elad I Levy ◽  
David Liebeskind ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Retrospective Analysis ◽  
Endovascular Therapy ◽  
High Volume ◽  
Artery Occlusion ◽  
Large Artery ◽  
Anterior Circulation

Background and Purpose: Endovascular techniques are frequently employed to treat large artery occlusion in acute ischemic stroke (AIS). We sought to determine the predictors and clinical impact of intracranial hemorrhage (ICH) after endovascular therapy. Methods: Retrospective analysis of consecutive patients presenting to 13 high-volume stroke centers with AIS due to proximal occlusion in the anterior circulation who underwent endovascular treatment within 8 hours from symptom onset. Logistic regression was performed to determine the variables associated with ICH, hemorrhagic infarction (HI), and parenchymal hematomas (PH) as well as 90-day poor outcome (mRS≥3), and mortality. Results: A total of 1122 patients (mean age, 67±15 years; median NIHSS, 17 [IQR13-20]) were studied. Independent predictors for HI included diabetes mellitus (OR 2.27, 95%CI [1.58-3.26], p<0.0001), pre-procedure IV tPA (1.43[1.03-2.08], p<0.037), Merci thrombectomy (1.47[1.02-2.12], p<0.032), and longer time to puncture (1.001[1.00-1.002], p<0.026). Patients with atrial fibrillation (1.61[1.01-2.55], p<0.045) had a higher risk of parenchymal hematomas (PH) while the use of intra-arterial tPA (0.57[0.35-0.90], p<0.008) was associated with lower chances of PH. Both the presence of HI (2.23[1.53-3.25], p< 0.0001) and PH (6.24[3.06-12.75], p< 0.0001) were associated with poor functional outcomes; however, only PH was associated with higher mortality (3.53[2.19-5.68], p<0.0001). Conclusions: In AIS patients undergoing endovascular therapy, diabetes mellitus, longer time to treatment, and Merci thrombectomy appear to be associated with a higher risk for HI while atrial fibrillation appears to result in a higher risk for PH. While both HI and PH are associated with poor outcomes only PH is associated with higher mortality.

scholarly journals E.09 Predictors of optimal endovascular therapy results among patients with acute ischemic stroke

2016 ◽  
Vol 43 (S2) ◽  
pp. S18-S18
Author(s):  
D Catana ◽  
J Badhiwala ◽  
A Koziarz ◽  
K Reddy ◽  
SA Almenawer
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Mechanical Thrombectomy ◽  
Combined Therapy ◽  
Arterial Occlusion ◽  
Functional Independence ◽  
Sensitivity Analyses ◽  
Care Group ◽  
Functional Benefit

Background: Several studies have demonstrated the safety and efficacy of endovascular therapy for patients with acute ischemic stroke. However, patient, imaging and treatment factors associated with the optimal functional outcome require better definition. Methods: We pooled data from 8 randomized controlled trials (SYNTHESIS, MR RESCUE, IMS III, MR CLEAN, ESCAPE, EXTEND-IA, SWIFT-PRIME, and REVASCAT). We conducted subgroup and sensitivity analyses to evaluate predictors of optimal functional results (modified Rankin scale, mRS) at 90 days. Results: Meta-analysis of 8 trials including 2,423 patients yielded that endovascular therapy resulted in 44.6% functional independence (mRS 0-2) versus 31.8% in the usual care group (OR 1.71, 95% CI 1.18-2.49, P=0.005). This treatment effect was significantly greater among patients with confirmed angiographic imaging of proximal arterial occlusion (OR 2.24, 95% CI 1.72-2.90, P<0.001), in patients who received the combined therapy of intravenous tPA and endovascular intervention (OR 2.07, 95% CI 1.46-2.92, P<0.001), and when using stent retriever for mechanical thrombectomy (OR 2.39, 95% CI 1.88-3.04, P<0.001). Conclusions: The relative functional benefit associated with endovascular therapy among patients with acute ischemic stroke was increased when combined with intravenous tPA, with confirmed proximal arterial occlusion on angiographic imaging, and with use of stent retrievers for mechanical thrombectomy.

Abstract T MP9: Primary Thrombectomy Within 3 Hours Of Onset In Acute Ischemic Stroke From Occlusion Of Middle Cerebral Artery- A Pilot Study

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Yahia M Lodi ◽  
Varun V Reddy ◽  
Anas Hourani ◽  
Karmel Shehadeh ◽  
Joe Chou ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Pilot Study ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Cerebral Artery ◽  
Large Artery ◽  
Related Complication ◽  
Mca Occlusion ◽  
Randomized Controlled Studies

Background: Acute ischemic stroke (AIS) due to large artery occlusion (LAO) with high NIHSS (>10), especially in internal carotid artery terminus (ICA-T) are resistant to IV thrombolysis and endovascular thrombectomy is associated with better recanalization rates. IV thrombolysis in large clot burden (>8mm) (LCB) in the middle cerebral artery (MCA) is associated with poor recanalization and may impact outcome. However, thrombectomy in AIS with LAO within 3 hours is performed as secondary therapy after IV thrombolysis. Objectives: To evaluate the feasibility, safety and recanalization rate of primary thrombectomy within 3 hours in AIS with NIHSS >10 from occlusion of MCA with LCB. Additionally, we like to report the functional outcome. Methods: Based on institutionally approved protocol patients with LAO (ICA-T, MCA, vertebral-basilar artery) with LCB within 3 hours were offered primary thrombectomy as an alternative to IV rtPA. They were entered into a stroke database. Patients who underwent primary MCA thrombectomy within 3 hours from 2012 to 2014 were retrospectively analyzed using SAS software. Outcomes were measured using modified Rankin Scale (mRS).Results: 10 patients with MCA occlusion ;mean age 65±15.87 years and mean NIHSS 16±; chose primary thrombectomy after informed consent. Thrombectomy was performed using stent-retriever device in addition to intra-arterial rtPA (2-4 mg). Mean number of passes was 1.4±.7. Near complete (TICI2b) and complete (TICI3) recanalization was observed in all patients. Mean time to recanalization from symptoms onset was 160±37 minutes. Immediate post-thrombectomy, 24 hour and 30 day NIHSS score was 2.6±1.4, 1.9±3.7 and 0 respectively. There was no procedure related complication. Asymptomatic perfusion related hemorrhage developed in 3 patients. 30 day good outcome was observed in all cases (mRS0= 30%, mRS1=50%, mRS2=20%).Conclusion: Our pilot study demonstrates that primary thrombectomy in AIS due to MCA occlusion with LCB is not only feasible and safe, but associated with complete recanalization and good functional outcome. Larger randomized controlled studies are needed.

MIDDLE CEREBRAL ARTERY STENTING FOR ACUTE ISCHEMIC STROKE AFTER UNSUCCESSFUL MERCI RETRIEVAL

Neurosurgery ◽  
2007 ◽  
Vol 60 (4) ◽  
pp. 701-706 ◽  
Author(s):  
Eric Sauvageau ◽  
Rodney M. Samuelson ◽  
Elad I. Levy ◽  
Alison M. Jeziorski ◽  
Ricky A. Mehta ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Scale Score ◽  
Cerebral Artery ◽  
National Institutes Of Health ◽  
High Rate ◽  
Vessel Occlusion ◽  
Intracranial Stenting ◽  
Acute Cerebral Ischemia

Abstract OBJECTIVE Intracranial stenting has been used in the treatment of ischemic stroke caused by acute intracranial vessel occlusion after unsuccessful recanalization with the Merci retriever. We describe our early experience with this technique. METHODS Patients who had intra-arterial therapy for acute ischemic stroke with concomitant use of the retriever between February 1, 2005 and May 2, 2006 were identified from our endovascular database. Cases in which recanalization was not achieved with the retriever and in which stenting was attempted as a secondary means of mechanical recanalization were retrospectively reviewed. RESULTS Ten patients with unsuccessful Merci retrieval underwent intracranial stenting. The average admission National Institutes of Health Stroke Scale score was 16.4. Occlusions were located in the middle cerebral artery (six extended into M2 branches). Four patients received intra-arterial reteplase (two prestent, one preretriever and poststent, and one poststent). Eptifibatide was administered immediately before stenting in every patient. Successful recanalization (thrombolysis in myocardial infarction 2 or 3) was achieved in nine out of 10 patients. Complications included an extradural perforation with arteriovenous fistula. Six patients had intracranial hematoma and/or subarachnoid hemorrhage; there were four deaths. The six surviving patients experienced at least a 6-point National Institutes of Health Stroke Scale improvement at discharge, although only one had a modified Rankin Scale score of 2 or less. CONCLUSION Angiographic recanalization has been associated with improvement in clinical outcome after acute cerebral ischemia. Recanalization is not always achieved using the Merci retriever. We found that stenting after unsuccessful Merci retrieval resulted in a high rate of angiographic success. Further research into refining indications and optimizing outcome is warranted.

scholarly journals Inflammatory factors are associated with early neurological deterioration in acute ischemic stroke patients receiving endovascular therapy-The AISRNA study

2020 ◽  
Author(s):  
Qi-Wen Deng ◽  
Shi Huang ◽  
Shuo Li ◽  
Qian Zhai ◽  
Qing Zhang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Time Course ◽  
Molecular Mechanisms ◽  
Interleukin 2 ◽  
Neurological Deterioration ◽  
Inflammatory Factors ◽  
Large Artery ◽  
Early Neurological Deterioration

Abstract Background: This study aimed to explore several peripheral blood-based markers related to inflammatory response in a total of 85 patients with acute ischemic stroke (AIS) caused by large artery occlusion in the anterior circulation receiving endovascular therapy (EVT) from the AISRNA study regarding the association between inflammatory factors and early neurological deterioration (END), and investigated whether their time course correlated with END after EVT.Methods: We collected baseline characteristics of 85 AIS patients participating in an observational acute stroke cohort: the AISRNA study. The following inflammatory factors were measured in these participants: interleukin-2 [IL-2], IL-4, IL-6, IL-10, tumor necrosis factor-α [TNF-α], and interferon-γ [IFN-γ]. The National Institute of Health Stroke Scale score increase of ≥4 within 24 hours after EVT defined as END.Results: IL-6 and IL-10 were higher in patients with END compared to those with non-END (P<0.01), and they were also associated with risk factors of END after EVT. Furthermore, we found that the area under curves (AUCs) of IL-6 and IL-10 for predicting END were 0.791 (0.689-0.871), and 0.564 (0.452-0.671), respectively. Adjusting for age, sex, and atrial fibrillation, the odds ratios (ORs; 95% confidence interval) for incident END for IL-6 and IL-10 were 1.83 (1.08-6.36) and 1.15 (1.02-1.30), respectively. Additionally, we found significant changes over time in the expression levels of IL-4, IL-6, and IL-10 in patients undergoing END compared with non-END (P<0.05).Conclusions: IL-6 and IL-10 levels on admission are significantly associated with END after EVT, and time course of IL-4, IL-6, and IL-10 is correlated with stroke progression. Further study of molecular mechanisms on peripheral immunomodulation in AIS would be helpful.Trial registration: ClinicalTrials.gov NCT04175691. Registered November 21, 2019.

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