Predictors of Functional Dependence Despite Successful Revascularization in Large-Vessel Occlusion Strokes

Abstract

Background and Purpose High revascularization rates in large-vessel occlusion strokes treated by mechanical thrombectomy are not always associated with good clinical outcomes. We evaluated predictors of functional dependence despite successful revascularization among patients with acute ischemic stroke treated with thrombectomy. Methods We analyzed the pooled data from the Multi Mechanical Embolus Removal in Cerebral Ischemia (MERCI), Thrombectomy Revascularization of Large Vessel Occlusions in Acute Ischemic Stroke (TREVO), and TREVO 2 trials. Successful revascularization was defined as thrombolysis in cerebral infarction score 2b or 3. Functional dependence was defined as a score of 3 to 6 on the modified Rankin Scale at 3 months. We assessed relationship of demographic, clinical, angiographic characteristics, and hemorrhage with functional dependence despite successful revascularization. Results Two hundred and twenty-eight patients with successful revascularization had clinical outcome follow-up. The rates of functional dependence with endovascular success were 48.6% for Trevo thrombectomy and 58.0% for Merci thrombectomy. Age (odds ratio, 1.04; 95% confidence interval, 1.02–1.06 per 1-year increase), National Institutes of Health Stroke Scale score (odds ratio, 1.08; 95% confidence interval, 1.02–1.15 per 1-point increase), and symptom onset to endovascular treatment time (odds ratio, 1.11; 95% confidence interval, 1.01–1.22 per 30-minute delay) were predictors of functional dependence despite successful revascularization. Symptom onset to reperfusion time beyond 5 hours was associated with functional dependence. All subjects with symptomatic intracranial hemorrhage had functional dependence. Conclusions One half of patients with successful mechanical thrombectomy do not have good outcomes. Age, severe neurological deficits, and delayed endovascular treatment were associated with functional dependence despite successful revascularization. Our data support efforts to minimize delays to endovascular therapy in patients with acute ischemic stroke to improve outcomes.

Clinical Effectiveness and Safety Outcomes of Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke in China

“…In accordance with previous studies, our study also found that old age [27], severe neurological deficits [27], high baseline glucose level [28], pneumonia [29,] and sICH [30] were independent predictors for poor functional outcome. Moreover, small baseline infarct core (ASPECTS 8-10) [31], successful revascularization (mTICI 2b-3) [27,32], good collateral status (2-3) [33,34], and OTT ≤6 h [27,35,36] were protective factors.…”

“…Moreover, small baseline infarct core (ASPECTS 8-10) [31], successful revascularization (mTICI 2b-3) [27,32], good collateral status (2-3) [33,34], and OTT ≤6 h [27,35,36] were protective factors. As shown in our study, sICH was the strongest predictor, which was associated with 14 times increased risk for poor functional outcome.…”

NADPH oxidase inhibitor improves outcome of mechanical reperfusion by suppressing hemorrhagic transformation

“…However, rapid reperfusion may lead to reperfusion injury and hemorrhagic transformation (HT) in acute stroke 4 5. Minor HT is usually inconsequential, but the parenchymal hematoma has been shown to be associated with a poor clinical outcome 3 6 7. Preventing severe HT is the next frontier of stroke intervention.…”

Thrombectomy using Trevo ProVue Stent Retriever Devices after Recombinant Tissue Plasminogen Activator Thrombolysis for Acute Basilar Artery Occlusion during Vertebral Artery Dissection

“…The clinical course under medical treatment, including intravenous heparin therapy, is extremely severe, with a mortality rate ranging from 40% to 86% (1). The major predictive factor for a good outcome is the speed of occluded vessel recanalization (2,3). According to recent publications, mechanical thrombectomy seems to be a safe and efficient technique for achieving recanalization in cases of acute arterial occlusion (4)(5)(6).…”