Predictors of Outcomes With Catheter-Based Therapy for Acute Stroke

Abstract

Background: Timely reperfusion directly impacts favorable neurologic outcomes in acute ischemic stroke (AIS) patients. Most strokes present outside the 3-4.5 h window for intravenous thrombolysis (IV-tPA). Catheter-based therapy (CBT) is commonly used in patients not eligible for timely IV-tPa, but variables that predict good neurologic outcomes are poorly understood. Methods: Results of 124 consecutive AIS patients who received CBT at Ochsner Medical Center from 2006 and 2012 are reported. A modified Rankin score (mRs) of 2 at 90 day post-CBT was used as the primary measurement of a good neurologic outcome. All-cause mortality during the index hospitalization, 30 days from treatment, and at 1 year were reported. Results are reported as those treated by Interventional Cardiologists (IC) or by Neurointerventionalists (NI). Results: The mean age was 65 6 16 years of which 48% (n 5 52) were male. The mean NIHSS was 15.0 6 7.5. Thrombolysis in cerebral infarction (TICI) 2 flow was achieved in 80% (n 5 100). Good neurologic outcome was observed in 64% (n 5 37 of 58) of patients 65 years or younger while in those older than 65, only 36% (n 5 24 of 66) had the same outcome (P 5 0.002). Mortality at 30 days for the two age groups were 21% (n 5 12) vs. 50% (n 5 33) (P 5 <0.001) respectively. A good neurologic outcome at 90 days was seen in 57% of patients with restoration of TICI 2 flow compared to 17% with TICI < 2 flow (P 5 <0.001). Those with failed reperfusion (TICI<2 flow) had 30-day mortality rate of 54% (13 of 24) vs. 20% (19 of 97) in those with TICI 2 flow (P 5 <0.001). At 90 days, there was no significant differences in patient outcomes between IC (n 5 58) and NI (n 5 66) treated patients. Conclusion: Successful revascularization with CBT leads to a good neurologic outcome in selected stroke patients. Medical co-morbidities and increased age > 65 years contributed to poor outcomes. To support broadening the number of physicians qualified to perform catheter-based stroke interventions, this study demonstrates that IC participating on a stroke team achieve comparable outcomes to NI. V C 2014 Wiley Periodicals, Inc.

Operator for stroke interventions

“…This idea was given support by a recent publication by Htyte et al 7 with cardiologists from our institution, which reported that between 2006 and 2012, neurointerventionalists and cardiologists had similar outcomes after acute stroke neurointervention. As the neurointerventionalists for the Ochsner system, we must point out the limitations of this study.…”

“…We believe that the conclusions of the paper by Htyte et al 7 were based on incomplete and uncorroborated data. No neurologists, vascular neurologists, or neurointerventionalists were invited to assist either with data acquisition and/or analysis, or with coauthoring the paper.…”