Abstract
To date, inconsistent results evaluating the effect of parameters on mechanical thrombectomy (MT) outcomes in stroke-patients have been published. This study aimed to identify the key parameters for functional status after MT in stroke-patients in short and long-term follow-up. Method: The study analysis focused on the relevance of selected clinical and non-clinical parameters to the functional status of the patients after MT. Results: 417 stroke-patients (mean age 67.8 ± 13.2 years) were qualified. Atrial fibrillation, and leukocytosis were significant for the neurological status on the first day of stroke (p = 0.036, and p = 0.0004, respectively). The parameters with the strongest effect on the functional status on day 10 were: age (p = 0.009), NIHSS (p = 0.002), hyperglycemia (p = 0.009), the result in TICI (p = 0.046), and first pass effect (p = 0.043). The parameters with the strongest effect on the functional status on day 365 were: age and NIHSS on the first day of stroke (p = 0.0002 and 0.002, respectively). Leukocytosis and the neurological status at baseline were key parameters associated with ICB after MT (p = 0.007 and p = 0.003, respectively). Conclusions: Age and neurological status in the ultra-acute phase of stroke are crucial for the functional status in short and long-term observations of patients treated with mechanical thrombectomy. Atrial fibrillation, hyperglycemia, and inflammatory state are relevant to the short-term post-stroke functional status. First pass effect and the degree of post-interventional reperfusion are important technical parameters to the short-term functional status. Neurological status and white blood count during the acute phase are associated with a high rate of post-procedural intracranial bleeding.
Highlights
In 2013, after the results of three studies on the efficacy of mechanical thrombectomy (MT) in acute stroke were analyzed, the future of MT was uncertain [1,2,3]
A total of 417 stroke patients (mean age 67.8 ± 13.2 years; mean 70 (20–92)); female: 47.7%) hospitalized between 2019 and 2020, who were treated with mechanical thrombectomy due to stroke were qualified for the retrospective study
The results indicate an adverse effect of elevated leukocytosis on the first day of stroke, and of elevated C-reactive protein (CRP), on the risk of intracranial bleeding (ICB) and the functional status of patients on the first days following onset
Summary
In 2013, after the results of three studies on the efficacy of mechanical thrombectomy (MT) in acute stroke were analyzed, the future of MT was uncertain [1,2,3]. It was demonstrated that 46% of patients undergoing MT in the course of acute stroke could function independently three months later (as opposed to 26.5% of individuals in the pharmacological treatment group) Those who benefited from endovascular treatment (OR 3.68, 95% CI 1.95–6.92) were patients aged ≥80 as well as randomized patients >300 min after the onset (1.76, 1.05–2.97). MT results in recanalization of more than 80% of the arteries involved in the intervention, no more than 50% of patients manage to return to complete independence within three months following stroke [9] This means that in half of the patients, a successful angiographic outcome does not guarantee optimal clinical benefits. If factors affecting the safety and efficacy of MT could be identified, that results would influence the selection of patients for the procedure and optimize the efficacy of endovascular procedures in stroke
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