Pretreatment predictors of very poor clinical outcomes in medium vessel occlusion stroke patients treated with mechanical thrombectomy

Author:

Yedavalli Vivek1ORCID,Salim Hamza12ORCID,Musmar Basel3,Adeeb Nimer3,El Naamani Kareem4,Henninger Nils56ORCID,Sundararajan Sri Hari7,Kühn Anna Luisa8,Khalife Jane9,Ghozy Sherief10,Scarcia Luca11,Tan Benjamin YQ1213ORCID,Heit Jeremy J14,Regenhardt Robert W2,Cancelliere Nicole M15ORCID,Bernstock Joshua D16,Rouchaud Aymeric17,Fiehler Jens18,Sheth Sunil19,Essibayi Muhammed Amir20,Puri Ajit S8,Dyzmann Christian21,Colasurdo Marco22,Barreau Xavier23,Renieri Leonardo24,Filipe João Pedro25,Harker Pablo26,Radu Răzvan Alexandru27ORCID,Marotta Thomas R15,Spears Julian15,Ota Takahiro28ORCID,Mowla Ashkan29,Jabbour Pascal4ORCID,Biswas Arundhati30,Clarençon Frédéric31ORCID,Siegler James E9ORCID,Nguyen Thanh N3233ORCID,Varela Ricardo34,Baker Amanda20,Altschul David20,Gonzalez Nestor R35ORCID,Möhlenbruch Markus A36,Costalat Vincent27,Gory Benjamin3738,Paul Stracke Christian39,Aziz-Sultan Mohammad Ali16,Hecker Constantin40,Shaikh Hamza9,Liebeskind David S41,Pedicelli Alessandro42ORCID,Alexandre Andrea M42ORCID,Tancredi Illario43,Faizy Tobias D44,Kalsoum Erwah11,Lubicz Boris45,Patel Aman B2,Pereira Vitor Mendes15,Guenego Adrien45ORCID,Dmytriw Adam A215ORCID

Affiliation:

1. Division of Neuroradiology, Department of Radiology, Johns Hopkins Medical Center, Baltimore, MD, USA

2. Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA

3. Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Baton Rouge, LA, USA

4. Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA

5. Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA

6. Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

7. Department of Endovascular Neurosurgery and Neuroradiology NJMS, Newark, NJ, USA

8. Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA

9. Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, USA

10. Departments of Neurological Surgery & Radiology, Mayo Clinic, Rochester, MN, USA

11. Department of Neuroradiology, Henri Mondor Hospital, Creteil, France

12. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore

13. Division of Neurology, Department of Medicine, National University Hospital, Singapore

14. Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA

15. Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael’s Hospital, Toronto, ON, Canada

16. Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston MA, USA

17. University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France

18. Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

19. Department of Neurology, UTHealth McGovern Medical School, Houston, TX, USA

20. Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

21. Neuroradiology Department, Sana Kliniken, Lübeck GmbH, Lübeck, Germany

22. Department of Interventional Radiology, Oregon Health & Science University, Portland, OR, USA

23. Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France

24. Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy

25. Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal

26. Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA

27. Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France

28. Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan

29. Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

30. Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA

31. Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France

32. GRC BioFast, Sorbonne University, Paris VI, Paris, France

33. Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA

34. Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal

35. Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, USA

36. Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany

37. Department of Interventional Neuroradiology, Nancy University Hospital, Nancy, France

38. INSERM U1254, IADI, Université de Lorraine, Vandoeuvre-les-Nancy, France

39. Department of Radiology, Interventional Neuroradiology Section, University Medical Center Münster, Münster, Germany

40. Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria

41. UCLA Stroke Center and Department of Neurology Department, University of California, Los Angeles, Los Angeles, CA, USA

42. UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy

43. Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium

44. Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Münster, Germany

45. Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium

Abstract

Background: Acute ischemic stroke (AIS) from primary medium vessel occlusions (MeVO) is a prevalent condition associated with substantial morbidity and mortality. Despite the common use of mechanical thrombectomy (MT) in AIS, predictors of poor outcomes in MeVO remain poorly characterized. Methods: In this prospectively collected, retrospectively reviewed, multicenter, multinational study, data from the MAD-MT (Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy) registry were analyzed. The study included 1568 patients from 37 academic centers across North America, Asia, and Europe, treated with MT, with or without intravenous tissue plasminogen activator (IVtPA), between September 2017 and July 2021. Results: Among the 1568 patients, 347 (22.2%) experienced very poor outcomes (modified Rankin score (mRS), 5–6). Key predictors of poor outcomes were advanced age (odds ratio (OR): 1.03; 95% confidence interval (CI): 1.02 to 1.04; p < 0.001), higher baseline National Institutes of Health Stroke Scale (NIHSS) scores (OR: 1.07; 95% CI: 1.05 to 1.10; p < 0.001), pre-operative glucose levels (OR: 1.01; 95% CI: 1.00 to 1.02; p < 0.001), and a baseline mRS of 4 (OR: 2.69; 95% CI: 1.25 to 5.82; p = 0.011). The multivariable model demonstrated good predictive accuracy with an area under the receiver-operating characteristic (ROC) curve of 0.76. Conclusions: This study demonstrates that advanced age, higher NIHSS scores, elevated pre-stroke mRS, and pre-operative glucose levels significantly predict very poor outcomes in AIS-MeVO patients who received MT. These findings highlight the importance of a comprehensive risk assessment in primary MeVO patients for personalized treatment strategies. However, they also suggest a need for cautious patient selection for endovascular thrombectomy. Further prospective studies are needed to confirm these findings and explore targeted therapeutic interventions.

Publisher

SAGE Publications

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