Predictors of futile recanalization in patients undergoing endovascular treatment in the DIRECT-MT trial

Zhou, Tengfei; Yi, Tingyu; Li, Tianxiao; Zhu, Ling; Liu, Yucheng; Li, Zhaoshuo; Wang, Meiyun; Li, Qiang; He, Yingkun; Yang, Pengfei; Zhang, Yongwei; Li, Zifu; Zhang, Yongxin; Ye, Xiaofei; Chen, Wenhuo; Wang, Shouchun; Liu, Jianmin

doi:10.1136/neurintsurg-2021-017765

Cited by 30 publications

(52 citation statements)

References 23 publications

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“…The mean age of the 99 patients who met the inclusion criteria was 72 years (IQR, 66-80) and 50.5% of these patients were women. The median baseline NIHSS score was 16 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22), and the median baseline ASPECTS score was seven (IQR, 5-8). The numbers of patients who had occlusions in the ICA (isolated, T-or L-shaped, and tandem occlusions), M1, and M2 were 35 (35.4), 53 (53.5), and 11 (11.1%), respectively.…”

Section: Resultsmentioning

confidence: 99%

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Predictors of futile recanalization in patients with acute ischemic stroke undergoing mechanical thrombectomy in late time windows

Liu

Hang

et al. 2022

Front. Neurol.

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Background and purposeFutile recanalization (FR), defined as functional dependence despite successful reperfusion, is common in patients who experience an acute stroke after thrombectomy. We aimed to determine the predictors of FR in patients who underwent thrombectomy in late time windows (6 h or more after symptom onset).MethodsThis retrospective review included patients who underwent thrombectomy for acute anterior circulation large vessel occlusion from October 2019 to June 2021. Successful reperfusion was defined as a modified Thrombolysis in Cerebral Infarction (mTICI) score of 2b/3. Functional dependence at 90 days was defined as a modified Rankin scale score of 3–6. Multivariate analysis and a receiver operating characteristic (ROC) curve were used to identify the predictors of FR in patients treated in delayed time windows.ResultsOf the 99 patients included, FR was observed in 51 (51.5%). In the multivariate analysis, older age (OR, 1.12; 95% CI, 1.04–1.22; P = 0.005), female sex (OR, 3.79; 95% CI, 1.08–13.40; P = 0.038), a higher National Institutes of Health Stroke Score (NIHSS) score upon admission (OR, 1.11; 95% CI, 1.02–1.22; P = 0.023), and an increased number of passes per procedure (OR, 2.07; 95% CI, 1.11–3.86; P = 0.023) were independently associated with FR after thrombectomy. The ROC curve indicated that the model that combined age, female sex, baseline NIHSS score, and the number of passes per procedure (area under the curve, 0.84; 95% CI, 0.75–0.90, P < 0.001) was able to predict FR accurately.ConclusionsOlder age, female sex, higher NIHSS score upon admission, and an increased number of passes per procedure were independent predictors of FR in patients who experienced acute ischemic strokes after thrombectomy in late time windows.

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Section: Resultsmentioning

confidence: 99%

“…Many previous studies have identified predictors of FR after endovascular treatment in early time windows in patients with AIS (5)(6)(7)(8)(9)(10)(11)(12). However, few studies have investigated the predictors of FR in patients treated with MT in late time windows.…”

Section: Introductionmentioning

confidence: 99%

Predictors of futile recanalization in patients with acute ischemic stroke undergoing mechanical thrombectomy in late time windows

Liu

Hang

et al. 2022

Front. Neurol.

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“…Several generic markers including age, gender, stroke severity, time from onset to puncture, and comorbidities (hypertension, diabetes, and atrial fibrillation) have been reported associated with clinical outcomes after EVT ( 4 , 7 , 22 ). In the present study, we also identified that the unfavorable functional outcome group was older, and had higher proportion of female, higher incidence of diabetes mellitus, and higher baseline NIHSS scores.…”

Section: Discussionmentioning

confidence: 99%

Plasma Lipid Mediators Associate With Clinical Outcome After Successful Endovascular Thrombectomy in Patients With Acute Ischemic Stroke

Hao

Feng

et al. 2022

Front. Immunol.

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BackgroundNeuroinflammatory response contributes to early neurological deterioration (END) and unfavorable long-term functional outcome in patients with acute ischemic stroke (AIS) who recanalized successfully by endovascular thrombectomy (EVT), but there are no reliable biomarkers for their accurate prediction. Here, we sought to determine the temporal plasma profiles of the bioactive lipid mediators lipoxin A4 (LXA4), resolvin D1 (RvD1), and leukotriene B4 (LTB4) for their associations with clinical outcome.MethodsWe quantified levels of LXA4, RvD1, and LTB4 in blood samples retrospectively and longitudinally collected from consecutive AIS patients who underwent complete angiographic recanalization by EVT at admission (pre-EVT) and 24 hrs post-EVT. The primary outcome was unfavorable long-term functional outcome, defined as a 90-day modified Rankin Scale score of 3-6. Secondary outcome was END, defined as an increase in National Institutes of Health Stroke Scale (NIHSS) score ≥4 points at 24 hrs post-EVT.ResultsEighty-one consecutive AIS patients and 20 healthy subjects were recruited for this study. Plasma levels of LXA4, RvD1, and LTB4 were significantly increased in post-EVT samples from AIS patients, as compared to those of healthy controls. END occurred in 17 (20.99%) patients, and 38 (46.91%) had unfavorable 90-day functional outcome. Multiple logistic regression analyses demonstrated that post-EVT levels of LXA4 (adjusted odd ratio [OR] 0.992, 95% confidence interval [CI] 0.987-0.998), ΔLXA4 (adjusted OR 0.995, 95% CI 0.991-0.999), LTB4 (adjusted OR 1.003, 95% CI 1.001-1.005), ΔLTB4 (adjusted OR 1.004, 95% CI 1.002-1.006), and post-EVT LXA4/LTB4 (adjusted OR 0.023, 95% CI 0.001-0.433) and RvD1/LTB4 (adjusted OR 0.196, 95% CI 0.057-0.682) ratios independently predicted END, and post-EVT LXA4 levels (adjusted OR 0.995, 95% CI 0.992-0.999), ΔLXA4 levels (adjusted OR 0.996, 95% CI 0.993-0.999), and post-EVT LXA4/LTB4 ratio (adjusted OR 0.285, 95% CI 0.096-0.845) independently predicted unfavorable 90-day functional outcome. These were validated using receiver operating characteristic curve analyses.ConclusionsPlasma lipid mediators measured 24 hrs post-EVT were independent predictors for early and long-term outcomes. Further studies are needed to determine their causal-effect relationship, and whether the imbalance between anti-inflammatory/pro-resolving and pro-inflammatory lipid mediators could be a potential adjunct therapeutic target.

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“…The final cohort included 2261 patients: median (IQR) age 75 years (64-83), 46% female, median NIHSS 9 (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). 34% received IVT alone, 41% MT alone and 25% both acute recanalization treatments (bridging approach).…”

Section: Baseline Characteristicsmentioning

confidence: 99%

Multivariable Prediction Model for Futile Recanalization Therapies in Patients With Acute Ischemic Stroke

et al. 2022

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Background and Objectives:Very poor outcome despite intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) occurs in about 1 of 4 patients with ischemic stroke and is associated with a high logistic and economic burden. We aimed to develop and validate a multivariable prognostic model to identify futile recanalization therapies (FRT) in patients undergoing those therapies.Materials and Methods:Patients from a prospectively collected observational registry of a single academic stroke center treated with MT and/or IVT were included. The dataset was split into a training (N=1808, 80%) and internal validation (N=453, 20%) cohort. We used gradient boosted decision tree machine-learning models after k-NN imputation of 32 variables available at admission to predict FRT defined as modified Rankin-Scale (mRS) 5-6 at 3 months. We report feature importance, ability for discrimination, calibration and decision curve analysis.Results:2261 patients with a median (IQR) age 75 years (64-83), 46% female, median NIHSS 9 (4-17), 34% IVT alone, 41% MT alone, 25% bridging were included. Overall 539 (24%) had FRT, more often in MT alone (34%) as compared to IVT alone (11%). Feature importance identified clinical variables (stroke severity, age, active cancer, prestroke disability), laboratory values (glucose, CRP, creatinine), imaging biomarkers (white matter hyperintensities) and onset-to-admission time as the most important predictors. The final model was discriminatory for predicting 3-month FRT (AUC 0.87, 95% CI 0.87-0.88) and had good calibration (Brier 0.12, 0.11-0.12). Overall performance was moderate (F1-score 0.63 ± 0.004) and decision curve analyses suggested higher mean net benefit at lower thresholds of treatment (up to 0.8).Conclusions:This FRT prediction model can help inform shared decision making and identify the most relevant features in the emergency setting. While it might be particularly useful in low resource healthcare settings, incorporation of further multifaceted variables is necessary to further increase the predictive performance.

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Predictors of futile recanalization in patients undergoing endovascular treatment in the DIRECT-MT trial

Cited by 30 publications

References 23 publications

Predictors of futile recanalization in patients with acute ischemic stroke undergoing mechanical thrombectomy in late time windows

Predictors of futile recanalization in patients with acute ischemic stroke undergoing mechanical thrombectomy in late time windows

Plasma Lipid Mediators Associate With Clinical Outcome After Successful Endovascular Thrombectomy in Patients With Acute Ischemic Stroke

Multivariable Prediction Model for Futile Recanalization Therapies in Patients With Acute Ischemic Stroke

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