Abstract
Background and Purpose: Successful reperfusion is a significant predictor of a good clinical outcome after mechanical thrombectomy (MT). However, some patients have a poor clinical outcome even with successful reperfusion. We aimed to study factors that predict a poor clinical outcome (90-day modified Rankin Scale ≥ 3) in patients with anterior circulation large vessel occlusion (LVO) treated by successful MT within 6 h of symptom onset.Methods: We performed a retrospective review of a prospectively maintained MT database of all patients who underwent MT within 6 h of symptom onset for an anterior circulation LVO at our institution from May 2016 to June 2018. Uni- and multivariable analyses were performed to identify predictors of poor outcome.Results: A total of 56 patients met the criteria for inclusion in this study. A poor outcome occurred in 31 (55.4%) patients. On univariate analysis, compared to patients with good clinical outcome, patients with poor outcome had higher mean baseline NIHSS scores (23.3 vs. 13.8, P < 0.001), were more likely to have internal carotid artery (ICA) occlusions (38.7 vs. 8%, P = 0.008), and had a higher incidence of distal clot migration (DCM) (48.4 vs. 8%, P = 0.028). Age, gender, other baseline clinical characteristics, MT technique, and incidence of hemorrhagic transformation did not differ between the two cohorts. On multivariable regression analysis, baseline NIHSS score [OR; 1.3, 95%CI [1.11–1.52], P = 0.001], site of occlusion (ICA) [OR; 8.9, 95%CI [1.3–60.9], P = 0.026], and DCM [OR; 5.77, 95%CI [1.09–30.69], P = 0.04] were independent predictors of poor outcome at 90-days.Conclusion: Baseline NIHSS score, ICA occlusion, and DCM are independent predictors of a poor outcome after MT for anterior circulation LVO performed within 6 h of symptoms onset.
Highlights
Stroke is the third leading cause of death in developed countries and the most common cause of permanent disability [1]
Baseline National Institute of Health Stroke Scale (NIHSS) score [OR; 1.3, 95%CI [1.11–1.52], P = 0.001], site of occlusion (ICA) [OR; 8.9, 95%CI [1.3–60.9], P = 0.026], and Distal clot migration (DCM) [OR; 5.77, 95%CI [1.09–30.69], P = 0.04] were independent predictors of poor outcome at 90-days
Patients were included in the study if they had anterior circulation large vessel occlusion (LVO), presented within 6 h of symptom onset, and underwent Mechanical thrombectomy (MT) with successful reperfusion defined as achievement of modified Thrombolysis In Cerebral Infarction of 2b-3
Summary
Stroke is the third leading cause of death in developed countries and the most common cause of permanent disability [1]. Mechanical thrombectomy (MT) within 6 h of symptom onset is the standard treatment for acute ischemic stroke (AIS) due to anterior circulation emergent large vessel occlusion (ELVO) [2]. Despite the use of modern era devices and techniques for MT, which has enhanced the speediness and completeness of reperfusion of the downstream territory, the likelihood of a good functional outcome (modified Rankin Scale, mRS0-2) at 90 days was 46% with many procedures are futile [6]. We aimed to evaluate the predictors of poor functional outcome at 90-days in patients with successful recanalization within 6 h of symptom onset. Successful reperfusion is a significant predictor of a good clinical outcome after mechanical thrombectomy (MT). We aimed to study factors that predict a poor clinical outcome (90-day modified Rankin Scale ≥ 3) in patients with anterior circulation large vessel occlusion (LVO) treated by successful MT within 6 h of symptom onset
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