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

Tajima, Yosuke; Hayasaka, Michihiro; Ebihara, Koichi; Kubota, Masaaki; Suda, Satoshi

doi:10.1055/s-0037-1612600

Cited by 10 publications

(21 citation statements)

References 21 publications

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“…In line with our findings, other studies report no significantly increased rates of sICH in EVT patients on anticoagulation [23,27,28] . A recent study found higher rates of sICH in patients on warfarin but not on NOACs, when compared to non-anticoagulated cases [29] . A previous study reported no difference in sICH rates between warfarin and NOACs, but the number of patients on a NOAC was small [23] .…”

Section: Discussionmentioning

confidence: 92%

Comparison of functional outcomes after endovascular thrombectomy in patients with and without atrial fibrillation

Fu¹,

Cappelen‐Smith²,

Edwards³

et al. 2021

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Aim: Patients with atrial fibrillation (AF) are over-represented in endovascular thrombectomy (EVT) populations, due to a high prevalence of large vessel occlusions (LVO) and contraindication to intravenous thrombolysis. This study aimed to: (1) compare 90-day functional outcomes [modified Rankin Score (mRS) 0-2] and mortality in AF vs. non-AF patients receiving EVT; (2) compare 90-day functional outcomes and mortality in AF patients on therapeutic vs. non-therapeutic anticoagulation receiving EVT; and (3) identify factors influencing outcomes in AF patients receiving EVT.Methods: A retrospective analysis of 394 consecutive patients who received EVT for anterior cerebral circulation LVO at an Australian comprehensive stroke center was performed. The main outcome measures [90-day dichotomized mRS (0-2 good; 3-6 poor functional outcome) and mortality] were compared between AF and non-AF patients, as well as between therapeutic and non-therapeutic anticoagulation cohorts.Results: In total, 171 (49%) EVT patients had AF. Patients with AF were older, had higher NIHSS, and had lower rates of thrombolysis administration. AF patients showed improved 90-day mRS on multivariate analysis [aOR 1.988 (1.167-3.387)], with similar symptomatic intracranial hemorrhage (sICH) [aOR 0.364 (0.064-2.086)] and mortality ]. There was no difference in 90-day mRS ], successful reperfusion rates )], or mortality [aOR 1.077 (0.429-2.705)] between AF patients on therapeutic vs. non-therapeutic anticoagulation. In patients with AF, advancing age and higher NIHSS were independent predictors of worse 90-day functional outcome (OR = 1.045, P = 0.020; OR = 1.086, P = 0.001) and mortality (OR = 1.138, P < 0.001; OR = 1.107, P = 0.002). On multivariate analysis, thrombolysis administration improved mortality (OR = 0.215, P = 0.016) but not functional outcomes. Conclusion:Patients with AF showed improved 90-day functional outcome, with similar mortality and sICH, after EVT. Therapeutic anticoagulation did not adversely influence EVT outcomes.

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Section: Discussionmentioning

confidence: 92%

Comparison of functional outcomes after endovascular thrombectomy in patients with and without atrial fibrillation

Fu¹,

Cappelen‐Smith²,

Edwards³

et al. 2021

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“…1 Factors such as age, National Institutes of Health Stroke Scale (NIHSS) score at baseline, and Alberta Stroke Program Early CT Score (ASPECTS) are associated with poor outcome after successful reperfusion. [2][3][4][5] A better understanding of the key determinants of poor recovery despite successful reperfusion after EVT could guide researchers and physicians in the development of new treatments to further improve outcomes. Therefore, we aimed to quantify the importance of predictors of poor functional outcome despite successful reperfusion.…”

Section: Introductionmentioning

confidence: 99%

Predictors of poor outcome despite successful endovascular treatment for ischemic stroke: results from the MR CLEAN Registry

Graaf¹,

Samuels

Chalos

et al. 2021

J NeuroIntervent Surg

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BackgroundApproximately one-third of patients with ischemic stroke treated with endovascular treatment do not recover to functional independence despite rapid and successful recanalization. We aimed to quantify the importance of predictors of poor functional outcome despite successful reperfusion.MethodsWe analyzed patients from the MR CLEAN Registry between March 2014 and November 2017 with successful reperfusion (extended Thrombolysis In Cerebral Infarction ≥2B). First, predictors were selected based on expert opinion and were clustered according to acquisition over time (ie, baseline patient factors, imaging factors, treatment factors, and postprocedural factors). Second, several models were constructed to predict 90-day functional outcome (modified Rankin Scale (mRS)). The relative importance of individual predictors in the most extensive model was expressed by the proportion of unique added χ2 to the model of that individual predictor.ResultsOf 3180 patients, 1913 (60%) had successful reperfusion. Of these 1913 patients, 1046 (55%) were functionally dependent at 90 days (mRS >2). The most important predictors for mRS were baseline patient factors (ie, pre-stroke mRS, added χ2 0.16; National Institutes of Health Stroke Scale score at baseline, added χ2 0.12; age, added χ2 0.10), and postprocedural factors (ie, symptomatic intracranial hemorrhage (sICH), added χ2 0.12; pneumonia, added χ2 0.09). The probability of functional independence for a typical stroke patient with sICH was 54% (95% CI 36% to 72%) lower compared with no sICH, and 21% (95% CI 4% to 38%) for pneumonia compared with no pneumonia.ConclusionBaseline patient factors and postprocedural adverse events are important predictors of poor functional outcome in successfully reperfused patients with ischemic stroke. This implies that prevention of postprocedural adverse events has the greatest potential to further improve outcomes in these patients.

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“…A comprehensive analysis of thirty-nine studies [8,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46]51], comprising a total of 11,700 patients, was conducted to assess the pooled prevalence of FR in AIS patients (Figure 2). The meta-analysis revealed an estimated pooled prevalence of 51%, with a range between 48% and 54% (ES 51%; 95% CI 48-54%; z = 47.66; p < 0.001) (Table 2 and Figure 2).…”

Section: Prevalence Of Futile Recanalizationmentioning

confidence: 99%

“…Twenty-two studies [11,15,17,19,[21][22][23][24][25]28,[30][31][32][33][34]39,40,[42][43][44][45]51], with a cumulative cohort of 5455 patients, examined the pooled prevalence of FR in AIS patients through retrospective studies (Figure 2). The meta-analysis indicated an estimated pooled prevalence of 51%, with a range from 46% to 56% (ES 51%; 95% CI 46-56%; z = 31.07; p < 0.001) (Table 4).…”

Section: Prevalence Of Fr In Retrospective Studiesmentioning

confidence: 99%

“…Seventeen studies [11,16,[22][23][24]30,32,33,[38][39][40][43][44][45][46][47][48], comprising a total of 3452 patients, assessed the estimated pooled prevalence of FR amongst AIS patients in Asia (Figure 2). The meta-analysis revealed an estimated pooled prevalence of 53%, ranging from 49% to 58% (ES 53%; 95% CI 49-58%; z = 34.09; p < 0.001).…”

Section: Prevalence Of Fr In Asiamentioning

confidence: 99%

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Comprehensive Meta-Analysis of Futile Recanalization in Acute Ischemic Stroke Patients Undergoing Endovascular Thrombectomy: Prevalence, Factors, and Clinical Outcomes

Shen,

Killingsworth,

Bhaskar

2023

Life

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Background: Futile recanalization (FR) continues to raise concern despite the success of endovascular thrombectomy (EVT) in acute ischemic stroke (AIS). Understanding the prevalence of FR and identifying associated factors are crucial for refining patient prognoses and optimizing management strategies. Objectives: This study aims to comprehensively assess the pooled prevalence of FR, explore the diverse factors connected with FR, and establish the association of FR with long-term clinical outcomes among AIS patients undergoing EVT. Materials and Methods: Incorporating studies focusing on FR following EVT in AIS patients, we conducted a random-effect meta-analysis to assess the pooled prevalence and its association with various clinical and imaging risk factors linked to FR. Summary estimates were compiled and study heterogeneity was explored. Results: Our comprehensive meta-analysis, involving 11,700 AIS patients undergoing EVT, revealed a significant pooled prevalence of FR at 51%, with a range of 48% to 54% (Effect Size [ES]: 51%; 95% Confidence Interval [CI]: 48–54%; z = 47.66; p < 0.001). Numerous clinical factors demonstrated robust correlations with FR, including atrial fibrillation (Odds Ratio [OR]: 1.39, 95% CI 1.22 1.59; p < 0.001), hypertension (OR 1.65, 95% CI 1.41 1.92; p < 0.001), diabetes mellitus (OR 1.71, 95% CI 1.47 1.99; p < 0.001), previous stroke or transient ischemic attack (OR 1.298, 95% CI 1.06 1.59; p = 0.012), prior anticoagulant usage (OR 1.33, 95% CI 1.08 1.63; p = 0.007), cardioembolic strokes (OR 1.34, 95% CI 1.10 1.63; p = 0.003), and general anesthesia (OR 1.53, 95% CI 1.35 1.74; p < 0.001). Conversely, FR exhibited reduced likelihoods of smoking (OR 0.66, 95% CI 0.57 0.77; p < 0.001), good collaterals (OR 0.33, 95% CI 0.23 0.49; p < 0.001), male sex (OR 0.87, 95% CI 0.77 0.97; p = 0.016), and intravenous thrombolysis (IVT) (OR 0.75, 95% CI 0.66 0.86; p < 0.001). FR was strongly associated with increasing age (standardized mean difference [SMD] 0.49, 95% CI 0.42 0.56; p < 0.0001), baseline systolic blood pressure (SMD 0.20, 95% CI 0.13 0.27; p < 0.001), baseline National Institute of Health Stroke Severity Score (SMD 0.75, 95% CI: 0.65 0.86; p < 0.001), onset-to-treatment time (SMD 0.217, 95% CI 0.13 0.30; p < 0.001), onset-to-recanalization time (SMD 0.38, 95% CI 0.19; 0.57; p < 0.001), and baseline blood glucose (SMD 0.31, 95% CI 0.22 0.41; p < 0.001), while displaying a negative association with reduced baseline Alberta Stroke Program Early CT Score (ASPECTS) (SMD −0.37, 95% CI −0.46 −0.27; p < 0.001). Regarding clinical outcomes, FR was significantly associated with increased odds of symptomatic intracranial hemorrhages (OR 7.37, 95% CI 4.89 11.12; p < 0.001), hemorrhagic transformations (OR 2.98, 95% CI 2.37 3.75; p < 0.001), and 90-day mortality (OR 19.24, 95% CI 1.57 235.18; p = 0.021). Conclusions: The substantial prevalence of FR, standing at approximately 51%, warrants clinical consideration. These findings underscore the complexity of FR in AIS patients and highlight the importance of tailoring management strategies based on individual risk factors and clinical profiles.

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

Cited by 10 publications

References 21 publications

Comparison of functional outcomes after endovascular thrombectomy in patients with and without atrial fibrillation

Comparison of functional outcomes after endovascular thrombectomy in patients with and without atrial fibrillation

Predictors of poor outcome despite successful endovascular treatment for ischemic stroke: results from the MR CLEAN Registry

Comprehensive Meta-Analysis of Futile Recanalization in Acute Ischemic Stroke Patients Undergoing Endovascular Thrombectomy: Prevalence, Factors, and Clinical Outcomes

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