Clinical and Non-Clinical Determinants of the Effect of Mechanical Thrombectomy and Post-Stroke Functional Status of Patients in Short and Long-Term Follow-Up

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.

What You Always Wanted to Know about Endovascular Therapy in Acute Ischemic Stroke but Never Dared to Ask: A Comprehensive Review

“…Patient-specific characteristics such as age or prestroke disability should not exclude patients from endovascular therapy when imaging criteria support MT [230][231][232]. Although the overall outcomes in octo-and nonagenarians are poorer than those in patients below 80 years of age, these patients benefit from endovascular stroke therapy [230,233]. Older patients and those with (unspecified) pre-stroke disability appear to show similar improvement rates to those in independently living patients, and the prestroke functional status can be attained [232].…”

Age Is Only a Number Also in Hyperacute Stroke Care—But Not an Irrelevant One

“…One of these uncertainties concerns patient age. While it is now clear that the elderly can also benefit from both tPA and EVT, they seem to gain less from these treatments than younger patients [ 7 , 8 , 9 , 10 , 11 , 12 ]. Additionally, although at least in Finland the elderly are in better shape than has previously been the case, it is also clear that, in general, older patients have a poorer prognosis and, in particular, shorter post-stroke survival times compared to younger patients [ 13 , 14 , 15 , 16 ].…”