{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T15:37:53Z","timestamp":1753889873572,"version":"3.41.2"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["SVIN"],"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Neurocritical care is routinely provided to patients post\u2010endovascular thrombectomy (EVT) for anterior large vessel occlusion strokes. We aim to study the relationship between immediate improvement in National Institutes of Health Stroke Scale (NIHSS) score on outcomes post\u2010EVT and potential implications for postprocedural care.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods<\/jats:title>\n            <jats:p xml:lang=\"en\">We performed a retrospective review of anterior circulation large vessel occlusion (internal carotid\/proximal middle cerebral artery) patients undergoing EVT. Demographic, clinical, and imaging information was analyzed. Ultra\u2010early functional improvement (UEFI) was defined as NIHSS score &lt;6 within 30 minutes of successful recanalization. We analyzed the incidence and predictors of UEFI, and explored reasons for neurological decline post\u2010UEFI.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Of the 343 anterior large vessel occlusion patients undergoing EVT, mean age was 71 \u00b1 15 and 46% were male. Mean NIHSS was 17 \u00b1 6 and Time Last Known Well (TLKW) to arrival was 9 \u00b1 11 hours. UEFI was observed in 23% (79\/343) of patients. Independent predictors of UEFI included lower pretreatment NIHSS, favorable Alberta Stroke Program Early CT Score (ASPECTS), and lower admission systolic blood pressure. Rates of 90\u2010day\u2010modified Rankin scale 0\u20132 were higher (71% versus 33%,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01) and the rate of mortality (8% versus 28%,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01) was lower in the UEFI group compared with the non\u2010UEFI group. Amongst patients with UEFI, 1.3% (1\/79) experienced increase in NIHSS by \u22654 points within 24 hours of EVT. This patient received thrombolysis, achieved TICI\u20102B recanalization, and follow\u2010up neuroimaging revealed a parenchymal hemorrhage and an infarct volume of 44 mL. None of the patients with UEFI required continuous antihypertensive infusions.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Approximately 1\u2010in\u20104 of anterior large vessel occlusion stroke patients undergoing EVT have an NIHSS score of &lt;6 within 30 minutes of successful recanalization. Only 1% of them experience significant decline in neurological status within 24 hours of the procedure with the majority achieving functional independence at 90 days. The need for advanced neurocritical care should be reevaluated in these patients.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/svin.121.000138","type":"journal-article","created":{"date-parts":[[2022,5,24]],"date-time":"2022-05-24T14:48:37Z","timestamp":1653403717000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Ultra\u2010Early Functional Improvement After Stroke Thrombectomy \u2013 Predictors and Implications"],"prefix":"10.1161","volume":"2","author":[{"given":"Shashvat M.","family":"Desai","sequence":"first","affiliation":[{"name":"Department of Neurology HonorHealth Research Institute Scottsdale AZ"},{"name":"Department of Neurology and Neurosurgery Barrow Neurological Institute Phoenix AZ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua S.","family":"Catapano","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurosurgery Barrow Neurological Institute Phoenix AZ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel A.","family":"Tonetti","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery University of Pittsburgh Medical Center Pittsburgh PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gautam","family":"Nayar","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery University of Pittsburgh Medical Center Pittsburgh PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kavit","family":"Shah","sequence":"additional","affiliation":[{"name":"Departments of Neurology University of Pittsburgh Medical Center Pittsburgh PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew A.","family":"Morrison","sequence":"additional","affiliation":[{"name":"Departments of Neurology University of Pittsburgh Medical Center Pittsburgh PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruchira M.","family":"Jha","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurosurgery Barrow Neurological Institute Phoenix AZ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tudor G.","family":"Jovin","sequence":"additional","affiliation":[{"name":"Department of Neurology Cooper University Hospital Camden NJ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9454-0678","authenticated-orcid":false,"given":"Ashutosh P.","family":"Jadhav","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurosurgery Barrow Neurological Institute Phoenix AZ"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000211"},{"key":"e_1_3_2_3_2","unstructured":"Mechanical Thrombectomy for Acute Stroke: Building Stroke Thrombectomy Systems of Care in Your Region: Why & How? https:\/\/www.svin.org\/files\/Final_formatted_SVIN_White_paper_2020_updated_references(1).pdf Society of Vascular and Interventional Neurology (SVIN). Date: October 24th 2020. Access Date: March 08 2022."},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000004597"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.118.021640"},{"key":"e_1_3_2_6_2","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1016\/S2213-2600(20)30580-4","article-title":"Allocating scarce intensive care resources during the COVID\u201019 pandemic: practical challenges to theoretical frameworks","volume":"9","author":"Supady A","year":"2021","unstructured":"Supady A, Curtis JR, Abrams D, Lorusso R, Bein T, Boldt J, Brown CE, Duerschmied D, Metaxa V, Brodie D. Allocating scarce intensive care resources during the COVID\u201019 pandemic: practical challenges to theoretical frameworks. Lancet Respir Med. 2021;9:430\u2013434.","journal-title":"Lancet Respir Med"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.117.005362"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2020.03.105"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.118.024067"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/ijs.12424"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1414905"},{"key":"e_1_3_2_12_2","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1161\/STROKEAHA.116.014456","article-title":"Early trajectory of stroke severity predicts long\u2010term functional outcomes in ischemic stroke subjects: results from the ESCAPE trial (endovascular treatment for small core and anterior circulation proximal occlusion with emphasis on minimizing CT to recanalization times)","volume":"48","author":"Sajobi TT","year":"2017","unstructured":"Sajobi TT, Menon BK, Wang M, Lawal O, Shuaib A, Williams D, Poppe AY, Jovin TG, Casaubon LK, Devlin T, et\u00a0al. Early trajectory of stroke severity predicts long\u2010term functional outcomes in ischemic stroke subjects: results from the ESCAPE trial (endovascular treatment for small core and anterior circulation proximal occlusion with emphasis on minimizing CT to recanalization times). Stroke. 2017;48:105\u2013110.","journal-title":"Stroke"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.118.024512"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.107.510321"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.112.671594"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2020-016111"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)00163-X"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1097\/NRL.0000000000000267"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-020-06092-5"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2000120"},{"key":"e_1_3_2_21_2","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1007\/BF03010674","article-title":"ICU and non\u2010ICU cost per day","volume":"42","author":"Norris C","year":"1995","unstructured":"Norris C, Jacobs P, Rapoport J, Hamilton S. ICU and non\u2010ICU cost per day. Can J Anaesth. 1995;42:192\u2013196.","journal-title":"Can J Anaesth"}],"container-title":["Stroke: Vascular and Interventional Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/SVIN.121.000138","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T15:40:51Z","timestamp":1715614851000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/SVIN.121.000138"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7]]},"references-count":20,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2022,7]]}},"alternative-id":["10.1161\/SVIN.121.000138"],"URL":"https:\/\/doi.org\/10.1161\/svin.121.000138","relation":{},"ISSN":["2694-5746"],"issn-type":[{"type":"electronic","value":"2694-5746"}],"subject":[],"published":{"date-parts":[[2022,7]]},"assertion":[{"value":"2021-07-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-12-02","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-05-24","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e000138"}}