Author:
Linfante Italo,Starosciak Amy K,Walker Gail R,Dabus Guilherme,Castonguay Alicia C,Gupta Rishi,Sun Chung-Huan J,Martin Coleman,Holloway William E,Mueller-Kronast Nils,English Joey D,Malisch Tim W,Marden Franklin A,Bozorgchami Hormozd,Xavier Andrew,Rai Ansaar T,Froehler Michael T,Badruddin Aamir,Nguyen Thanh N,Taqi M Asif,Abraham Michael G,Janardhan Vallabh,Shaltoni Hashem,Novakovic Roberta,Yoo Albert J,Abou-Chebl Alex,Chen Peng R,Britz Gavin W,Kaushal Ritesh,Nanda Ashish,Issa Mohammad A,Nogueira Raul G,Zaidat Osama O
Abstract
BackgroundMechanical thrombectomy with stent-retrievers results in higher recanalization rates compared with previous devices. Despite successful recanalization rates (Thrombolysis in Cerebral Infarction (TICI) score ≥2b) of 70–83%, good outcomes by 90-day modified Rankin Scale (mRS) score ≤2 are achieved in only 40–55% of patients. We evaluated predictors of poor outcomes (mRS >2) despite successful recanalization (TICI ≥2b) in the North American Solitaire Stent Retriever Acute Stroke (NASA) registry.MethodsLogistic regression was used to evaluate baseline characteristics and recanalization outcomes for association with 90-day mRS score of 0–2 (good outcome) vs 3–6 (poor outcome). Univariate tests were carried out for all factors. A multivariable model was developed based on backwards selection from the factors with at least marginal significance (p≤0.10) on univariate analysis with the retention criterion set at p≤0.05. The model was refit to minimize the number of cases excluded because of missing covariate values; the c-statistic was a measure of predictive power.ResultsOf 354 patients, 256 (72.3%) were recanalized successfully. Based on 234 recanalized patients evaluated for 90-day mRS score, 116 (49.6%) had poor outcomes. Univariate analysis identified an increased risk of poor outcome for age ≥80 years, occlusion site of internal carotid artery (ICA)/basilar artery, National Institute of Health Stroke Scale (NIHSS) score ≥18, history of diabetes mellitus, TICI 2b, use of rescue therapy, not using a balloon-guided catheter or intravenous tissue plasminogen activator (IV t-PA), and >30 min to recanalization (p≤0.05). In multivariable analysis, age ≥80 years, occlusion site ICA/basilar, initial NIHSS score ≥18, diabetes, absence of IV t-PA, ≥3 passes, and use of rescue therapy were significant independent predictors of poor 90-day outcome in a model with good predictive power (c-index=0.80).ConclusionsAge, occlusion site, high NIHSS, diabetes, no IV t-PA, ≥3 passes, and use of rescue therapy are associated with poor 90-day outcome despite successful recanalization.
Subject
Neurology (clinical),General Medicine,Surgery
Reference31 articles.
1. Predictors of good clinical outcomes, mortality, and successful revascularization in patients with acute ischemic stroke undergoing thrombectomy: pooled analysis of the Mechanical Embolus Removal in Cerebral Ischemia (MERCI) and Multi MERCI Trials;Nogueira;Stroke,2009
2. Safety of mechanical thrombectomy and intravenous tissue plasminogen activator in acute ischemic stroke. Results of the multi Mechanical Embolus Removal in Cerebral Ischemia (MERCI) trial, part I;Smith;AJNR Am J Neuroradiol,2006
3. Safety and efficacy of endovascular thrombectomy in patients with abnormal hemostasis: pooled analysis of the MERCI and multi MERCI trials;Nogueira;Stroke,2009
4. Mechanical thrombectomy for acute ischemic stroke: final results of the Multi MERCI trial;Smith;Stroke,2008
5. Solitaire flow restoration device versus the Merci Retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial;Saver;Lancet,2012