{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T18:11:56Z","timestamp":1787508716496,"version":"build-2736575974"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Coma in the first hours after anterior circulation ischemic stroke is rare. We aimed to assess the causes of coma and outcomes after endovascular thrombectomy (EVT) in this relatively unexplored subgroup of patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>We used data from the MR CLEAN Registry, a prospective, multicenter, observational cohort study of patients treated with EVT in the Netherlands between March 2014, and December 2018. We included patients with anterior circulation ischemic stroke treated within 6.5\u202fh of symptom onset and assessed frequency and causes of coma, defined as a score of 8 or lower on the Glasgow Coma Scale. Patients with a posterior circulation stroke were excluded. The primary outcome was the score on the modified Rankin Scale at 90\u202fdays. We compared outcomes of comatose and non-comatose patients with logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifty-two (1%) of 4,869 patients were comatose. The main causes of coma were bilateral ischemia, a post-ictal state after an epileptic seizure, and respiratory insufficiency. Comatose patients were less likely to receive intravenous thrombolysis (54% vs. 73%;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.004) and onset-to-groin times were longer (226 vs. 199\u202fmin;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.012). Patients with coma had poorer functional outcomes (adjusted common odds ratio (OR), 2.73; 95%CI: 1.45\u20135.13) and more frequently died within 90\u202fdays (adjusted OR, 2.95; 95%CI: 1.47\u20135.90).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Bilateral ischemia, a post-ictal state after an epileptic seizure and respiratory insufficiency are common causes of coma in patients with anterior circulation ischemic stroke treated with EVT. These patients have a high risk of death or dependency at 90\u202fdays.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2025.1524262","type":"journal-article","created":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T04:37:54Z","timestamp":1743482274000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Endovascular treatment in comatose patients with anterior circulation ischemic stroke"],"prefix":"10.3389","volume":"16","author":[{"given":"Wouter M.","family":"Sluis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone M.","family":"Uniken Venema","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anouk","family":"van der Hoorn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph C. J.","family":"Bot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wim H.","family":"van Zwam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeannette","family":"Hofmeijer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. Bart","family":"van der Worp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,4,1]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"104447","DOI":"10.1016\/j.jstrokecerebrovasdis.2019.104447","article-title":"Neurological deficits in stroke patients that may impede the capacity to provide informed consent for endovascular treatment trials","volume":"28","author":"Janssen","year":"2019","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"878","DOI":"10.1016\/S0140-6736(77)91201-6","article-title":"Aspects of coma after severe head injury","volume":"1","author":"Jennett","year":"1977","journal-title":"Lancet"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"2658","DOI":"10.1007\/s00415-024-12199-2","article-title":"Characterizing coma in large vessel occlusion stroke","volume":"271","author":"Young","year":"2024","journal-title":"J Neurol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1846","DOI":"10.1212\/WNL.58.12.1846","article-title":"Sudden coma from acute bilateral internal carotid artery territory infarction","volume":"58","author":"Kwon","year":"2002","journal-title":"Neurology"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1186\/s12871-015-0041-9","article-title":"The etiology and outcome of non-traumatic coma in critical care: a systematic review","volume":"15","author":"Horsting","year":"2015","journal-title":"BMC Anesthesiol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1177\/2396987319832140","article-title":"European stroke organisation (ESO) - European Society for Minimally Invasive Neurological Therapy (ESMINT) guidelines on mechanical Thrombectomy in acute Ischaemic StrokeEndorsed by stroke Alliance for Europe (SAFE)","volume":"4","author":"Turc","year":"2019","journal-title":"Eur Stroke J"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e344","DOI":"10.1161\/STR.0000000000000211","article-title":"Guidelines for the early Management of Patients with Acute Ischemic Stroke: 2019 update to the 2018 guidelines for the early Management of Acute Ischemic Stroke: a guideline for healthcare professionals from the American Heart Association\/American Stroke Association","volume":"50","author":"Powers","year":"2019","journal-title":"Stroke"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"k949","DOI":"10.1136\/bmj.k949","article-title":"MR CLEAN registry investigators. Endovascular treatment for acute ischaemic stroke in routine clinical practice: prospective, observational cohort study (MR CLEAN registry)","volume":"360","author":"Jansen","year":"2018","journal-title":"BMJ"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e1001885","DOI":"10.1371\/journal.pmed.1001885","article-title":"The REporting of studies conducted using observational routinely-collected health data (RECORD) statement","volume":"12","author":"Benchimol","year":"2015","journal-title":"PLoS Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1670","DOI":"10.1016\/S0140-6736(00)02237-6","article-title":"Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS study group. Alberta stroke Programme early CT score","volume":"355","author":"Barber","year":"2000","journal-title":"Lancet"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1002\/ana.21130","article-title":"Systematic comparison of perfusion-CT and CT-angiography in acute stroke patients","volume":"61","author":"Tan","year":"2007","journal-title":"Ann Neurol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"433","DOI":"10.1136\/neurintsurg-2018-014127","article-title":"eTICI reperfusion: defining success in endovascular stroke therapy","volume":"11","author":"Liebeskind","year":"2019","journal-title":"J Neurointerv Surg"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"2981","DOI":"10.1161\/STROKEAHA.115.010049","article-title":"The Heidelberg bleeding classification: classification of bleeding events after ischemic stroke and reperfusion therapy","volume":"46","author":"von Kummer","year":"2015","journal-title":"Stroke"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"891","DOI":"10.1212\/WNL.48.4.891","article-title":"Stroke recurrence: predictors, severity and prognosis. The Copenhagen Stroke Study","volume":"48","author":"Jerrgensen","year":"1997","journal-title":"Neurology"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1161\/STROKEAHA.119.027336","article-title":"Association between low blood pressure and clinical outcomes in patients with acute ischemic stroke","volume":"51","author":"Verschoof","year":"2020","journal-title":"Stroke"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1159\/000090528","article-title":"Hypoxemia in acute stroke is frequent and worsens outcome","volume":"21","author":"Rowat","year":"2006","journal-title":"Cerebrovasc Dis"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1186\/1471-2377-11-110","article-title":"Post-stroke infection: a systematic review and meta-analysis","volume":"11","author":"Westendorp","year":"2011","journal-title":"BMC Neurol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1177\/17474930211006290","article-title":"Malignant infarction after endovascular treatment: incidence and prediction","volume":"17","author":"Bernsen","year":"2022","journal-title":"Int J Stroke"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1097\/00003246-200301000-00043","article-title":"Timing of neurologic deterioration in massive middle cerebral artery infarction: a multicenter review","volume":"31","author":"Qureshi","year":"2003","journal-title":"Crit Care Med"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1001\/archneur.1996.00550040037012","article-title":"\u201cMalignant\u201d middle cerebral artery territory infarction: clinical course and prognostic signs","volume":"53","author":"Hacke","year":"1996","journal-title":"Arch Neurol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1002\/ana.22125","article-title":"Prediction of malignant middle cerebral artery infarction by magnetic resonance imaging within 6 hours of symptom onset: a prospective multicenter observational study","volume":"68","author":"Thomalla","year":"2010","journal-title":"Ann Neurol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1111\/cns.12030","article-title":"Thrombolysis on ischemic stroke patients with decreased level of consciousness within 4.5 h","volume":"19","author":"Chen","year":"2013","journal-title":"CNS Neurosci Ther"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1524262\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T04:37:57Z","timestamp":1743482277000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1524262\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,1]]},"references-count":22,"alternative-id":["10.3389\/fneur.2025.1524262"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2025.1524262","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,1]]},"article-number":"1524262"}}