Prediction of Poor Outcome after Successful Thrombectomy in Patients with Severe Acute Ischemic Stroke: A Pilot Retrospective Study

Abstract

Several baseline hematologic and metabolic laboratory parameters have been linked to acute ischemic stroke (AIS) clinical outcomes in patients who successfully recanalized. However, no study has directly investigated these relationships within the severe stroke subgroup. The goal of this study is to identify potential predictive clinical, lab, and radiographic biomarkers in patients who present with severe AIS due to large vessel occlusion and have been successfully treated with mechanical thrombectomy. This single-center, retrospective study included patients who experienced AIS secondary to large vessel occlusion with an initial NIHSS score ≥ 21 and were recanalized successfully with mechanical thrombectomy. Retrospectively, demographic, clinical, and radiologic data from electronic medical records were extracted, and laboratory baseline parameters were obtained from emergency department records. The clinical outcome was defined as the modified Rankin Scale (mRS) score at 90 days, which was dichotomized into favorable functional outcome (mRS 0–3) or unfavorable functional outcome (mRS 4–6). Multivariate logistic regression was used to build predictive models. A total of 53 patients were included. There were 26 patients in the favorable outcome group and 27 in the unfavorable outcome group. Age and platelet count (PC) were found to be predictors of unfavorable outcomes in the multivariate logistic regression analysis. The areas under the receiver operating characteristic (ROC) curve of models 1 (age only model), 2 (PC only model), and 3 (age and PC model) were 0.71, 0.68, and 0.79, respectively. This is the first study to reveal that elevated PC is an independent predictor of unfavorable outcomes in this specialized group.

Redefining CT perfusion‐based ischemic core estimates for the ghost core in early time window stroke

“…Protocol for imaging acquisition is as described previously by Yedavalli et al 16–18 . The CTP images were postprocessed using commercially available RAPID CTP software (v.5.1.1, iSchemaView Inc, Menlo Park, CA, USA, https://www.rapidai.com/rapid-ctp) for generation of quantitative rCBF, time‐to‐maximum (Tmax) volume, and qualitative Tmax maps 16,19–21 …”

“…com/rapid-ctp) for generation of quantitative rCBF, time-to-maximum (Tmax) volume, and qualitative Tmax maps. 16,[19][20][21] Treatment decisions, including administration of intravenous (IV) thrombolysis and or EVT, were per stroke team consensus. If EVT was pursued, devices used, number of passes, assessment of reperfusion, and termination of procedure were per the treating neurointerventionalist.…”