{
  "abstract": "Background\n\nRestoring blood flow to ischemic tissue is the cornerstone of acute stroke therapy and is usually beneficial. However, when reperfusion is achieved for severely injured tissue, it is often futile and may occasionally cause harm. We aim to determine the prevalence and variables associated with clinical no improvement or acute worsening at 24 hours despite reperfusion in patients with large-vessel occlusion stroke treated with endovascular thrombectomy.Methods\n\nData are from ESCAPE-NA1 (Safety and Efficacy of Nerinetide [NA-1] in Subjects Undergoing Endovascular Thrombectomy for Stroke), a randomized trial of nerinetide in patients with acute large-vessel occlusion stroke undergoing endovascular thrombectomy. Patients with unsuccessful recanalization (expanded Thrombolysis in Cerebral Infarction <2b), infarcts in new vascular territories, vessel perforation, or remote parenchymal hemorrhage were excluded. Clinical outcomes after reperfusion were classified by 24-hour National Institutes of Health Stroke Scale changes compared with baseline: improvement (≥4-point improvement), no improvement (±3-point from baseline), and worsening (≥4-point worsening). Baseline variables associated with worsening were identified using logistic regression. In the computed tomography perfusion subgroup, prevalence of parenchymal hemorrhage (any parenchymal hematoma) and infarct progression (final infarct volume exceeding the initial hypoperfused region) were evaluated.Results\n\nA total of 833 patients were included (median age, 70.9 years [interquartile range, 60.7-79.4]; 51.4% men). After reperfusion, 669 (80.3%) patients improved, 135 (16.2%) showed no improvement, and 29 (3.5%) worsened. Independent predictors of worsening were longer onset-to-reperfusion time (adjusted odds ratio, 1.02 [95% CI, 1.00-1.04] per 10-minute increase) and greater degree of sedation (adjusted odds ratio, 1.78 [95% CI, 1.29-2.46] per category of none, conscious sedation, and general anesthesia). In the computed tomography perfusion subgroup (n=414), among patients with worsening after reperfusion, parenchymal hemorrhage was seen in 5 patients (31.3%) and infarct progression in 4 patients (25%).Conclusions\n\nClinical worsening in the acute period (ie, early neurological deterioration) despite reperfusion and the absence of procedure-related complications was rare in this selected large-vessel occlusion stroke cohort (3.5%). Factors associated with worsening after reperfusion were a longer time from symptom onset-to-reperfusion and a higher degree of sedation.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Neurology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (U.P.).",
    "Department of Biomedical Sciences, Humanitas University, Milan, Italy (U.P.).",
    "Vancouver Stroke Program, Division of Neurology, University of British Columbia, Canada (T.S.F.).",
    "Departments of Radiology and Neurosurgery, McMaster University, Hamilton, ON, Canada (B.v.A.).",
    "Department of Neurology, Erlanger Hospital, Chattanooga, TN (R.S.).",
    "Department of Neurology, Pacific Neuroscience Institute, Santa Monica, CA (J.W.T.).",
    "Department of Neurology, Community Neurosciences Institute, Fresno, CA (H.C.).",
    "Department of Radiology (N.K.), University of Manitoba, Winnipeg, Canada.",
    "Department of Clinical Neurosciences (M.A., A.M.D., M.D.H.), University of Calgary, Alberta, Canada.",
    "Department of Neurology, University of Pittsburgh Medical Center Stroke Institute, University of Pittsburgh School of Medicine, PA (R.G.N.).",
    "Department of Neurology (R.A.M.), University of Manitoba, Winnipeg, Canada.",
    "Department of Neurology, CHUM-Centre hospitalier de l'Université de Montréal, QC, Canada (A.Y.P.).",
    "Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada (J.L.R.).",
    "Department of Radiology, Cumming School of Medicine (M.J., A.M.D., M.G., M.D.H., J.M.O.), University of Calgary, Alberta, Canada.",
    "Department of Medicine (Neurology), University of Ottawa and Ottawa Hospital Research Institute, ON, Canada (D.D.).",
    "Department of Neurosurgery, Institute of Medical Science (R.H.S.), University of Toronto, Canada.",
    "Department of Neurosurgery, Lyerly Neurosurgery, Baptist Medical Center Jacksonville, FL (E.S.).",
    "Faculty of Medicine and University Hospital Carl Gustav Carus, Department of Neurology, Technische Universität Dresden, Germany (V.P.).",
    "Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (B.C.V.C.).",
    "Department of Neuroradiology, Alfried Krupp Krankenhaus, Essen, Germany (R.C.).",
    "Krembil Research Institute, University Health Network (M.T.), University of Toronto, Canada."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 24,
  "authors": [
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      "name": "Umberto Pensato",
      "orcid": "0000-0002-4042-4735"
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      "name": "Thalia S Field",
      "orcid": "0000-0002-1176-0633"
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      "name": "Ruchir Shah"
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      "name": "Jason W Tarpley"
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      "name": "Hana Choe"
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        7
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      "name": "Nima Kashani",
      "orcid": "0000-0002-9752-784X"
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        8
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      "name": "Mohammed Almekhlafi",
      "orcid": "0000-0001-9550-8197"
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        9
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      "name": "Raul G Nogueira",
      "orcid": "0000-0003-4532-153X"
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        10
      ],
      "name": "Ryan A McTaggart",
      "orcid": "0000-0001-5853-5161"
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        11
      ],
      "name": "Alexandre Y Poppe",
      "orcid": "0000-0002-1419-2635"
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    {
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        12
      ],
      "name": "Jeremy L Rempel",
      "orcid": "0000-0003-2324-8415"
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      "name": "Manish Joshi",
      "orcid": "0000-0002-6400-8701"
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      "name": "Dar Dowlatshahi",
      "orcid": "0000-0003-1379-3612"
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    {
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      "name": "Richard H Swartz",
      "orcid": "0000-0001-6571-5531"
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    {
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        16
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      "name": "Eric Sauvageau",
      "orcid": "0000-0003-4399-1142"
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    {
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        17
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      "name": "Volker Puetz",
      "orcid": "0000-0003-1415-3027"
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      "name": "Bruce C V Campbell",
      "orcid": "0000-0003-3632-9433"
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      "name": "René Chapot",
      "orcid": "0000-0002-2584-8361"
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    {
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      "name": "Michael Tymianski",
      "orcid": "0000-0002-6311-9565"
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      "name": "Andrew M Demchuk",
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      "name": "Mayank Goyal",
      "orcid": "0000-0001-9060-2109"
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      "name": "Michael D Hill",
      "orcid": "0000-0002-6269-1543"
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    {
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        13
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      "name": "Johanna M Ospel",
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  "bibtex": "https://research.draconitic.com/paper/9kfz6z9j6xmzk.bib",
  "cited_by": 0,
  "doi": "10.1161/svin.126.002411",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13727238/?tool=EBI",
  "id": "9kfz6z9j6xmzk",
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  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
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  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
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  "native_subjects": [
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    [
      "heading",
      "Original Research"
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      "2713|Acute Ischemic Stroke Management"
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  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13727238/pdf/?tool=EBI",
  "pmcid": "PMC13727238",
  "pmid": "42974355",
  "published": "2026-09-24",
  "publisher": "Wolters Kluwer Health",
  "ris": "https://research.draconitic.com/paper/9kfz6z9j6xmzk.ris",
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      "field": "medicine",
      "origin": "openalex:2713|Acute Ischemic Stroke Management",
      "subfield": "epidemiology-public-health"
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  ],
  "title": "Clinical Improvement, No Improvement, and Worsening at 24 Hours Following Reperfusion in Patients With Stroke due to Large-Vessel Occlusion",
  "title_text": "Clinical Improvement, No Improvement, and Worsening at 24 Hours Following Reperfusion in Patients With Stroke due to Large-Vessel Occlusion",
  "type": "peer-reviewed",
  "updated_at": "2026-11-06T12:22:57Z",
  "url": "https://research.draconitic.com/paper/9kfz6z9j6xmzk",
  "venue": "Stroke (Hoboken, N.J.)",
  "versions": []
}