Predictive Factors for Good Outcome and Mortality After Stent-Retriever Thrombectomy in Patients With Acute Anterior Circulation Stroke

Abstract

Background and Purpose Predictive factors associated with stent-retriever thrombectomy for patients with acute anterior circulation stroke remain to be elucidated. This study aimed to investigate clinical and procedural factors predictive of good outcome and mortality after stent-retriever thrombectomy in a large cohort of patients with acute anterior circulation stroke.Methods We analyzed clinical and procedural data in 335 patients with acute anterior circulation stroke treated with stent-retriever thrombectomy. A good outcome was defined as a modified Rankin Scale score of 0 to 2 at 3 months. The associations between clinical, imaging, and procedural factors and good outcome and mortality, respectively, were evaluated using logistic regression analysis.Results Using multivariate analysis, age (odds ratio [OR], 0.965; 95% confidence interval [CI], 0.944-0.986; P=0.001), successful revascularization (OR, 4.658; 95% CI, 2.240-9.689; P<0.001), parenchymal hemorrhage (OR, 0.150; 95% CI, 0.049-0.460; P=0.001), and baseline NIHSS score (OR, 0.908; 95% CI, 0.855-0.965; P=0.002) were independent predictors of good outcome. Independent predictors of mortality were age (OR, 1.043; 95% CI, 1.002-1.086; P=0.041), successful revascularization (OR, 0.171; 95% CI, 0.079-0.370; P<0.001), parenchymal hemorrhage (OR, 2.961; 95% CI, 1.059-8.276; P=0.038), and a history of previous stroke/TIA (OR, 3.124; 95% CI, 1.340-7.281; P=0.008).Conclusions Age, revascularization status, and parenchymal hemorrhage are independent predictors of both good outcome and mortality after stent retriever thrombectomy for acute anterior circulation stroke. In addition, NIHSS score on admission is independently associated with good outcome, whereas a history of previous stroke is independently associated with mortality.

Importance of Reperfusion Status after Intra-Arterial Thrombectomy for Prediction of Outcome in Anterior Circulation Large Vessel Stroke

“…These models incorporate age and the severity of symptoms at presentation (NIHSS or Canadian Neurological Society score) and various variables such as prestroke mRS, ASPECTS, glucose at presentation, etiology of stroke, and medical history. However, previous studies have shown mTICI to be an important independent predictor of outcome [9-11] and this is not included in those models.…”

“…Patient selection for IAT has been studied extensively [2, 6-8], whereas prognostication after IAT is relatively understudied [8-11]. Previous studies designed prediction models for outcome after ischemic stroke; however, the degree of reperfusion status was often not accounted for [19-23].…”

Predictors of Poor Outcome after Successful Mechanical Thrombectomy in Patients with Acute Anterior Circulation Stroke

“…These findings are consistent with those of several previous studies that evaluated the independent predictors of clinical outcome after mechanical thrombectomy in patients with acute ischemic stroke owing to intracranial large vessel occlusion, which found that a younger age, lower NIHSS score on admission, successful revascularization, and shorter procedure time were independent predictors of good outcom. [7][8][9][10] Here, incomplete revascularization was significantly associated with a poor clinical outcome. Several previous studies examined or mentioned potential differences in outcome between patients with a TICI of 3 versus a TICI of 2b.…”

“…Of the 69 included patients, 35 (50.7%) had atrial fibrillation, 36 (52.2%) had hypertension, and 15 (21.7%) had diabetes mellitus. The patients' mean DWI-ASPECTS was 7.5 (range, [3][4][5][6][7][8][9][10][11]. Among the 69 patients, the occluded vessel was the ICA in 24 patients (34.8%), the MCA M1 portion in 41 patients (59.4%), and the MCA M2 portion in 4 patients (5.8%).…”

“…[1][2][3][4][5] Studies examining the predictors of poor outcome or mortality concluded that successful revascularization is a potent predictor of a favorable clinical outcome. [6][7][8] However, some patients have a poor clinical outcome, including mortality, despite successful mechanical thrombectomy. Currently, the factors related to the poor outcomes remain unknown.…”