What predicts poor outcome after successful thrombectomy in early time window?

Olivot, Jean‐Marc; Heit, Jeremy J; Mazighi, Mikaël; Raposo, Nicolas; Albucher, Jean François; Rousseau, Vanessa; Guenego, Adrien; Thalamas, Claire; Mlynash, Michael; Drif, Amel; Christensen, Søren; Sommet, Agnès; Viguier, Alain; Darcourt, Jean; Januel, Anne-Christine; Calvière, Lionel; Ménégon, Patrice; Caparros, François; Bonneville, Fabrice; Tourdias, Thomas; Sibon, Igor; Albers, Gregory W.; Cognard, Christophe

doi:10.1136/neurintsurg-2021-017946

Cited by 30 publications

(40 citation statements)

References 17 publications

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“…Conversely, one post-procedural factor emerged as significant predictor—the presence of hemorrhagic transformation on post-interventional imaging. This is concordant with previous studies both for posterior19 and anterior20 circulation thrombectomies.…”

Section: Discussionsupporting

confidence: 94%

Poor clinical outcome despite successful basilar occlusion recanalization in the early time window: incidence and predictors

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Finitsis

Arquizan

et al. 2022

J NeuroIntervent Surg

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BackgroundEndovascular treatment (EVT) for basilar artery occlusions (BAO) is associated with a higher rate of futile recanalization compared with anterior circulation procedures. We aimed to identify the incidence and predictors of poor clinical outcome despite successful reperfusion in current clinical practice.MethodsWe used data from the ETIS (Endovascular Treatment in Ischemic Stroke) registry, a prospective multicenter observational registry of stroke treated with EVT in France. Patients undergoing EVT for acute BAO from January 2014 to May 2019 successfully treated within 8 hours from onset were included. Predictors of 90-day poor outcome (modified Rankin Scale (mRS) 4–6) were researched within patients with successful (modified Thrombolysis In Cerebral Infarction (mTICI 2b-3)) and excellent (mTICI 2c-3) reperfusion.ResultsAmong 242 patients treated within 8 hours, successful reperfusion was achieved in 195 (80.5%) and excellent reperfusion in 120 (49.5%). Poor outcome was observed in 107 (54.8%) and 60 (50%) patients, respectively. In patients with successful early reperfusion, age, higher initial National Institutes of Health Stroke Scale (NIHSS) score, lower posterior circulation Alberta Stroke Programme Early CT Score (pc-ASPECTS), and absence of prior intravenous thrombolysis were independent predictors of poor outcome. The only treatment factor with an independent predictive value was first-pass mTICI 2b-3 reperfusion (adjusted OR 0.13, 95% CI 0.05 to 0.37, p<0.001). In patients with excellent early reperfusion, independent predictors were age, initial NIHSS score, first-pass mTICI 2c-3 reperfusion, and hemorrhagic transformation on post-interventional imaging.ConclusionsEarly successful reperfusion with EVT occurred in 80.5% of patients, and the only treatment-related factor predictive of clinical outcome was first pass mTICI 2b-3 reperfusion. Further research is warranted to identify the optimal techniques and devices associated with first pass reperfusion in the posterior circulation.

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Section: Discussionsupporting

confidence: 94%

Poor clinical outcome despite successful basilar occlusion recanalization in the early time window: incidence and predictors

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Finitsis

Arquizan

et al. 2022

J NeuroIntervent Surg

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“…For instance, our results suggest that CCC+ patients are highly likely to have a favorable outcome after thrombectomy treatment. Given that nearly half of patients who undergo successful thrombectomy do not have a favorable outcome, 28,29 our study suggests that the CCC+ profile may have important prognostic information in counseling patients and their families. In addition, patients with less favorable CCC− profiles may be an optimal group for enrollment of potential neuroprotective strategies given that they are unlikely to benefit from standard stroke therapies.…”

Section: Discussionmentioning

confidence: 88%

The Cerebral Collateral Cascade

et al. 2022

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Background and Purpose:Robust cerebral collaterals are associated with favorable outcomes in patients with acute ischemic stroke due to large vessel occlusion treated by thrombectomy. However, collateral status assessment mostly relies on single imaging biomarkers and a more comprehensive holistic approach may provide deeper insights into the biology of collateral perfusion on medical imaging. Comprehensive collateralization is defined as blood flow of cerebral arteries through the brain tissue and into draining veins. We hypothesized that a comprehensive analysis of the cerebral collateral cascade (CCC) on an arterial, tissue and venous level would predict clinical and radiological outcomes.Materials and Methods:Multicenter retrospective cohort study of acute stroke patients undergoing thrombectomy triage. CCC was determined by quantifying pial arterial collaterals, tissue-level collaterals, and venous outflow. Pial arterial collaterals were determined by CT angiography, tissue-level collaterals were assessed on CT perfusion. Venous outflow was assessed on CT angiography using the cortical vein opacification score. 3 groups were defined: CCC+ (good pial collaterals, tissue-level collaterals, and venous outflow), CCC- (poor pial collaterals, tissue-level collaterals, and venous outflow) and CCCmixed (remainder of patients). Primary outcome was functional independence (modified Rankin Scale: 0-2) at 90-days. Secondary outcome was final infarct volume.Results:647 patients met inclusion criteria: 176 CCC+, 345 CCC mixed and 126 CCC-. Multivariable ordinal logistic regression showed that CCC+ predicted good functional outcomes (OR=18.9 [95% CI 8-44.5]; p<0.001) compared to CCC- and CCCmixed patients. CCCmixed patients likely had better functional outcomes compared to CCC- patients (OR=2.5 [95% CI 1.2-5.4]; p=0.014). Quantile regression analysis (50th percentile) showed that CCC+ (β: -78.5, 95% CI -96.0- -61.1; p<0.001) and CCCmixed (β: -64.0, 95% CI -82.4- -45.6; p<0.001) profiles were associated with considerably lower final infarct volumes compared to CCC- profiles.Conclusion:Comprehensive assessment of the collateral blood flow cascade in acute stroke patients is a strong predictor of clinical and radiological outcomes in patients treated by thrombectomy.

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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%

“…Therefore, predicting FR in patients treated with MT in late time windows may help clinicians select more personalized therapy for patients undergoing MT and identify patients who need other timely adjuvant treatments. Predictors of FR in early time windows have received widespread attention, and several predictors have previously been identified, such as age, female sex, systolic blood pressure upon admission, serum glucose, baseline NIHSS score, time from onset to treatment, and post-procedural complication events (5)(6)(7)(8)(9)(10)(11)(12). In this study, we confined our analysis to patients with stroke who underwent treatment in late time windows and identified several clinical markers as independent predictors of poor outcomes after successful recanalization; these predictors could help manage these patients.…”

Section: Discussionmentioning

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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What predicts poor outcome after successful thrombectomy in early time window?

Cited by 30 publications

References 17 publications

Poor clinical outcome despite successful basilar occlusion recanalization in the early time window: incidence and predictors

Poor clinical outcome despite successful basilar occlusion recanalization in the early time window: incidence and predictors

The Cerebral Collateral Cascade

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

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