Status epilepticus after mechanical thrombectomy: the role of early eeg assessment in stroke unit, clinical and radiological prognostication

Background Convulsive (CSE) and non-convulsive (NCSE) status epilepticus are a complication in 0.2–0.3% ischemic strokes. Large stroke and cortical involvement are the main risk factors for developing SE. This study evaluates the prevalence of SE in patients treated with endovascular thrombectomy (EVT) through EEG recording within 72h from admission. Moreover, we compared clinical, radiological, and outcome measures in SE and no-SE patients. Materials and Methods We collected retrospectively demographical and clinical characteristics of acute ischemic stroke patients who underwent EVT, admitted in the Stroke Unit (SU) of the University Hospital of Trieste between January 2018 and March 2023 who underwent EEG recording within 72h from the symptoms’ onset. Results Out of 247 EVT patients, 138 met the inclusion criteria, of whom 9 (6.5%) showed SE with median onset time of 1 day (IQR 1-2). No difference was found between the two groups as for age, sex, risk factors, grade of recanalization, etiology of stroke, and closed vessel. The no-SE group presented higher NIHSS improvement rate (p=0.025) compared to the SE group. Insular lobe and basal ganglia were more frequently involved in the SE group (p=0.01, p=0.013, respectively). Conclusion SE after EVT in large strokes is a non-rare complication, with most being NCSE. Performing a rapid EEG assessment in a Stroke Unit setting may allow for a prompt recognition and treatment of SE in the acute/hyper-acute phase. SE may be correlated with worse clinical outcomes in patients with large vessel occlusion.