To describe the current characteristics of management and outcomes after END due to progressive or recurrent ischemia in patients with acute ischemic stroke.

The management and outcomes of early neurologic deterioration (END) after ischemic stroke specifically due to stroke progression or stroke recurrence have not been well delineated.  

Among 1,221 (age 69.7±13.2years, men 58.2%) patients with END due to stroke progression (SP) or stroke recurrence (SR), active management after END was implemented in 64.2%. Active management strategies were:  volume expansion, 29.2%; change in antithrombotic regimen, 26.1%; induced hypertension, 8.6%; rescue reperfusion therapy, 6.8%; intracranial pressure lowering with hyperosmolar agents, 1.5%; bypass surgery, 0.6%; and hypothermia, 0.1%. Active management strategies varying with patient features included volume expansion and induced hypertension use more often in large artery atherosclerosis and small vessel occlusion and rescue endovascular thrombectomy more common in other (dissection), cardioembolism, and large artery atherosclerosis. There were significant disparities of active managements among participating hospitals. Active management was associated with higher rates of freedom-from-disability (mRS 0-1; 24.3% vs 16.6%) and functional independence (mRS 0-2; 41.6% vs 27.7%) at 3-months. 

In this observational study, active management, undertaken in two-thirds of patients, was most often hemodynamic or antithrombotic and was associated with improved functional outcomes. These data highlight the need for and provide parameter for planning of randomized clinical trials of treatments for END arising from stroke progression or recurrence.