Back to Search Start Over

Motor evoked potentials during revascularization in ischemic stroke predict motor pathway ischemia and clinical outcome

Authors :
Bernhard Meyer
Tobias Greve
Sebastian Ille
Kornelia Kreiser
Claus Zimmer
Ehab Shiban
Benno Ikenberg
Arthur Wagner
Silke Wunderlich
Source :
Clinical Neurophysiology. 131:2307-2314
Publication Year :
2020
Publisher :
Elsevier BV, 2020.

Abstract

Objective The relevance of motor evoked potential (MEP) recovery during mechanical endovascular thrombectomy (MT) in patients with ischemic stroke is unclear. We correlated MEP recovery during MT to symptom improvement and to ischemia in eloquent motor areas on magnetic resonance imaging (MRI) and compared the predictive value of MEPs to visual angiographic reperfusion status, classified by modified Thrombolysis in Cerebral Infarction grading (mTICI). Methods Patients with hemisyndrome and large-vessel occlusion undergoing MT were included (n35, 49% females; 73.9 ± 14.5 years; n31 anterior circulation). MEPs were elicited transcranially and recorded at the abductor pollicis brevis muscle bilaterally throughout the procedure. An MRI was acquired within 7 days after MT. Results The median door-to-needle time was 3.5 hours. Median National Institutes of Health Stroke Scale at presentation was 16 (7 – 37). Median Modified Rankin Scale score was 4 at day 7 and 3 months. After MT, MEP-recovery occurred in 21 cases after a median time span of 4.5 min [range 2 – 11 min]. Symptom improvement at day 7 (3 months) was noted in 22 (21) cases. Absence of ischemia on postinterventional MRI was noted in 21 cases, 19 of whom showed MEP-recovery. Stratified for symptom improvement at day 7, sensitivity (specificity) of MEP-recovery was 86% (85%) and of mTICI ≥ 2b was 95% (23%). Stratified for absence of ischemia on postinterventional MRI, sensitivity (specificity) of MEP-recovery was 90% (86%) and of mTICI ≥ 2b was of 95% (21%). Conclusions MEP recovery occurs early after successful endovascular mechanical revascularization and is superior to mTICI grading in predicting postoperative neurological outcome and postoperative motor-pathway ischemia. Significance This is a new, significant and clinically important study since it emphasizes the additional value of MEP monitoring in a field, which has been traditionally unaffiliated with neurophysiological monitoring.

Details

ISSN :
13882457
Volume :
131
Database :
OpenAIRE
Journal :
Clinical Neurophysiology
Accession number :
edsair.doi.dedup.....a59bc5a3abf7065e2266f2a0c8a5f923
Full Text :
https://doi.org/10.1016/j.clinph.2020.05.026