Predictors of outcome after mechanical thrombectomy for acute ischemic stroke in patients aged ≥90 years

Sojka, Michał; Pyra, Krzysztof; Tarkowski, Piotr; Luchowski, Piotr; Wojczal, Joanna; Drelich-Zbroja, Anna; Jargiełło, Tomasz

doi:10.1016/j.clineuro.2020.106354

Cited by 7 publications

(10 citation statements)

References 28 publications

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“…In practice, the age of patients in our study was relatively young compared with some other studies (23,24). Sojka et al reported that the mortality after 90 days was as high as 47.4 % in acute ischemic stroke patients aged more than 90 years old (25). The baseline pcASPECTS and NIHSS scores represent the severity of stroke in patients, which in turn determines the prognosis of patients to a large extent, and this is confirmed by this study and previous investigations (12,16).…”

Section: Discussionmentioning

confidence: 58%

The efficacy and risk factors of mechanical thrombectomy for the treatment of vertebrobasilar artery occlusion: a single center study

Yao¹,

Xu²,

Zhou³

et al. 2021

Ann Palliat Med

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Background: The mortality of acute ischemic stroke patients caused by vertebrobasilar artery occlusion (VBAO) is high and mechanical thrombectomy has gradually become a promising treatment for acute ischemic stroke. This study analyzed the efficacy of mechanical thrombectomy and the risk factors associated with poor outcomes in VBAO patients caused by severe local atherosclerotic stenosis.Methods: This retrospective study enrolled patients with acute ischemic stroke caused by VBAO between March 1, 2016 and August 31, 2019. Patient demographic and clinical data were collected retrospectively. All enrolled patients were retrospectively interviewed for at least 3 months. Patients with a modified Rankin scale (mRS) score between 0 and 3 points were defined as having satisfactory outcomes while those with more than 3 points were defined as having unsatisfactory outcomes. In-hospital mortality, the rates of recanalization, and the rates of intracerebral hemorrhage were also recorded. Multivariable logistic regression was used to determine the risk factors of unsatisfactory outcomes in enrolled patients.Results: A total of 65 patients were enrolled in this study with a median age 69.0 (63.0-78.0) years and 48 patients (73.8%) were male. Approximately 50% of patients had a mRS score of 0 or 1 point within 90 days after treatment with mechanical thrombectomy and 14 patients had a mRS score of 6 points. A total of 11 patients died in hospital. Out of the 65 patients, 7 required recanalization and 9 patients suffered from intracerebral hemorrhage. Multivariate logistic regression analysis showed that older age, lower baseline posterior circulation acute stroke prognosis early CT score (pcASPECTS), higher baseline National Institutes of Health stroke scale (NIHSS) score, and residual stenosis were independent risk factors of both unsatisfactory outcomes and mortality of VBAO patients.Conclusions: This study confirmed the important role of mechanical thrombectomy in the treatment of acute ischemic stroke caused by VBAO and may provide some guidance for improving the prognosis of patients.

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Section: Discussionmentioning

confidence: 58%

The efficacy and risk factors of mechanical thrombectomy for the treatment of vertebrobasilar artery occlusion: a single center study

Yao¹,

Xu²,

Zhou³

et al. 2021

Ann Palliat Med

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“…Tziomalos et al (2017) reported that stress hyperglycemia was not an independent predictor of poor outcome but was rather associated with a more severe stroke (admission NIHSS). In regard to NIHSS score, early neurological change or the change of NIHSS score, rather than baseline score, was significantly and independently associated with 90-day outcomes (Heitsch et al, 2021. While, some studies found that a lower baseline score was associated with a favorable outcome (Sojka et al, 2021) and the performance of NIHSS score in predicting functional outcome was time-dependent (Wu et al, 2019). Therefore, the prognostic prediction power of glucose levels and baseline NIHSS score remains controversial.…”

Section: Discussionmentioning

confidence: 99%

Quantitative collateral score for the prediction of clinical outcomes in stroke patients: Better than visual grading

Zhang²,

Cao³

et al. 2022

Front. Neurosci.

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ObjectivesTo identify preoperative prognostic factors for acute ischemic stroke (AIS) patients receiving mechanical thrombectomy (MT) and compare the performance of quantitative collateral score (qCS) and visual collateral score (vCS) in outcome prediction.MethodsFifty-five patients with AIS receiving MT were retrospectively enrolled. qCS was defined as the percentage of the volume of collaterals of both hemispheres. Based on the dichotomous outcome assessed using a 90-day modified Rankin Scale (mRS), we compared qCS, vCS, age, sex, National Institute of Health stroke scale score, etiological subtype, platelet count, international normalized ratio, glucose levels, and low-density lipoprotein cholesterol (LDL-C) levels between favorable and unfavorable outcome groups. Logistic regression analysis was performed to determine the effect on the clinical outcome. The discriminatory power of qCS, vCS, and their combination with cofounders for determining favorable outcomes was tested with the area under the receiver-operating characteristic curve (AUC).ResultsvCS, qCS, LDL-C, and age could all predict clinical outcomes. qCS is superior over vCS in predicting favorable outcomes with a relatively higher AUC value (qCS vs. vCS: 0.81 vs. 0.74) and a higher sensitivity rate (qCS vs. vCS: 72.7% vs. 40.9%). The prediction power of qCS + LDL-C + age was best with an AUC value of 0.91, but the accuracy was just increased slightly compared to that of qCS alone.ConclusionCollateral scores, LDL-C and age were independent prognostic predictors for patients with AIS receiving MT; qCS was a better predictor than vCS. Furthermore, qCS + LDL-C + age offers a strong prognostic prediction power and qCS alone was another good choice for predicting clinical outcome.

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“…Within the MT group, successful reperfusion (ie, modified Treatment in Cerebral Ischemia score of 2b or 3) was achieved in 82 (80%), and incomplete reperfusion in 20 (20%) cases. Compared with the BMT group, the MT group had: higher NIHSS on admission (12 [IQR,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) versus 10 [5-18], P=0.22), shorter times from admission to imaging (min; 25 [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] versus 32 , P=0.01) and from admission to bolus (in the case of pretreatment with intravenous tissue-type plasminogen activator; 45 versus 59 [49-95], P=0.04), more often proximal LVO (M1 occlusion: 53% versus 40%, P=0.10), larger hypoperfusion volume (81 mL [IQR, 52-127] versus 52 mL [IQR, , P=0.01), and larger core-to-perfusion mismatch volume (69 mL [IQR, 43-100] versus 29 mL [IQR, 14-55], P≤0.001). All baseline characteristics are reported in Table 1.…”

Section: Baseline Characteristicsmentioning

confidence: 99%

“…We performed inverse probability of treatment weighting using the propensity score to assess the primary and secondary end points, controlling for confounding factors described in the literature as influencing functional outcome (see text section S2). 3,4,[25][26][27][28][29][30][31] These variables are: age, hypertension, diabetes, atrial fibrillation, occlusion site, NIHSS score at admission, premorbid mRS score, intravenous thrombolysis, time from onset to admission, blood glucose level at admission, systolic and diastolic blood pressure, ischemic core volume, and hypoperfusion lesion volume. In contrast to propensity score matching, inverse probability of treatment weighting does not lead to sample size loss, and yields valid results even with small sample sizes.…”

Section: Statistical Analysesmentioning

confidence: 99%

Mechanical Thrombectomy Versus Best Medical Treatment in the Late Time Window in Non-DEFUSE-Non-DAWN Patients: A Multicenter Cohort Study

Dittrich

Sporns

Kriemler

et al. 2023

Stroke

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Background: We assessed the efficacy and safety of mechanical thrombectomy (MT) in adult stroke patients with anterior circulation large vessel occlusion presenting in the late time window not fulfilling the DEFUSE-3 (Thrombectomy for Stroke at 6 to 16 Hours With Selection by Perfusion Imaging trial) and DAWN (Thrombectomy 6 to 24 Hours After Stroke With a Mismatch Between Deficit and Infarct trial) inclusion criteria. Methods: Cohort study of adults with anterior circulation large vessel occlusion admitted between 6 and 24 hours after last-seen-well at 5 participating Swiss stroke centers between 2014 and 2021. Mismatch was assessed by computer tomography or magnetic resonance imaging perfusion with automated software (RAPID or OLEA). We excluded patients meeting DEFUSE-3 and DAWN inclusion criteria and compared those who underwent MT with those receiving best medical treatment alone by inverse probability of treatment weighting using the propensity score. The primary efficacy end point was a favorable functional outcome at 90 days, defined as a modified Rankin Scale score shift toward lower categories. The primary safety end point was symptomatic intracranial hemorrhage within 7 days of stroke onset; the secondary was all-cause mortality within 90 days. Results: Among 278 patients with anterior circulation large vessel occlusion presenting in the late time window, 190 (68%) did not meet the DEFUSE-3 and DAWN inclusion criteria and thus were included in the analyses. Of those, 102 (54%) received MT. In the inverse probability of treatment weighting analysis, patients in the MT group had higher odds of favorable outcomes compared with the best medical treatment alone group (modified Rankin Scale shift: acOR, 1.46 [1.02–2.10]; P =0.04) and lower odds of all-cause mortality within 90 days (aOR, 0.59 [0.37–0.93]; P =0.02). There were no significant differences in symptomatic intracranial hemorrhage (MT versus best medical treatment alone: 5% versus 2%, P =0.63). Conclusions: Two out of 3 patients with anterior circulation large vessel occlusion presenting in the late time window did not meet the DEFUSE-3 and DAWN inclusion criteria. In these patients, MT was associated with higher odds of favorable functional outcomes without increased rates of symptomatic intracranial hemorrhage. These findings support the enrollment of patients into ongoing randomized trials on MT in the late window with more permissive inclusion criteria.

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Predictors of outcome after mechanical thrombectomy for acute ischemic stroke in patients aged ≥90 years

Cited by 7 publications

References 28 publications

The efficacy and risk factors of mechanical thrombectomy for the treatment of vertebrobasilar artery occlusion: a single center study

The efficacy and risk factors of mechanical thrombectomy for the treatment of vertebrobasilar artery occlusion: a single center study

Quantitative collateral score for the prediction of clinical outcomes in stroke patients: Better than visual grading

Mechanical Thrombectomy Versus Best Medical Treatment in the Late Time Window in Non-DEFUSE-Non-DAWN Patients: A Multicenter Cohort Study

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