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How Much of the Thrombectomy Related Improvement in Functional Outcome Is Already Apparent at 24 Hours and at Hospital Discharge?

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How Much of the Thrombectomy Related Improvement in Functional Outcome Is Already Apparent at 24 Hours and at Hospital Discharge? / Kniep, Helge; Meyer, Lukas; Bechstein, Matthias; Broocks, Gabriel; Guerreiro, Helena; van Horn, Noel; Brekenfeld, Caspar; Flottmann, Fabian; Deb-Chatterji, Milani; Alegiani, Anna; Thomalla, Götz; Hanning, Uta; Fiehler, Jens; Gellißen, Susanne; German Stroke Registry – Endovascular Treatment (GSR – ET).

in: STROKE, Jahrgang 53, Nr. 9, 09.2022, S. 2828-2837.

Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung

Harvard

Kniep, H, Meyer, L, Bechstein, M, Broocks, G, Guerreiro, H, van Horn, N, Brekenfeld, C, Flottmann, F, Deb-Chatterji, M, Alegiani, A, Thomalla, G, Hanning, U, Fiehler, J, Gellißen, S & German Stroke Registry – Endovascular Treatment (GSR – ET) 2022, 'How Much of the Thrombectomy Related Improvement in Functional Outcome Is Already Apparent at 24 Hours and at Hospital Discharge?', STROKE, Jg. 53, Nr. 9, S. 2828-2837. https://doi.org/10.1161/STROKEAHA.121.037888

APA

Kniep, H., Meyer, L., Bechstein, M., Broocks, G., Guerreiro, H., van Horn, N., Brekenfeld, C., Flottmann, F., Deb-Chatterji, M., Alegiani, A., Thomalla, G., Hanning, U., Fiehler, J., Gellißen, S., & German Stroke Registry – Endovascular Treatment (GSR – ET) (2022). How Much of the Thrombectomy Related Improvement in Functional Outcome Is Already Apparent at 24 Hours and at Hospital Discharge? STROKE, 53(9), 2828-2837. https://doi.org/10.1161/STROKEAHA.121.037888

Vancouver

Kniep H, Meyer L, Bechstein M, Broocks G, Guerreiro H, van Horn N et al. How Much of the Thrombectomy Related Improvement in Functional Outcome Is Already Apparent at 24 Hours and at Hospital Discharge? STROKE. 2022 Sep;53(9):2828-2837. https://doi.org/10.1161/STROKEAHA.121.037888

Bibtex

@article{64ca345a119b4b3fb6442945db6bd4d5,
title = "How Much of the Thrombectomy Related Improvement in Functional Outcome Is Already Apparent at 24 Hours and at Hospital Discharge?",
abstract = "BACKGROUND: Early neurological status has been described as predictor of functional outcome in patients with anterior circulation stroke after mechanical thrombectomy. It remains unclear to what proportion the improvement of functional outcome at day 90 is already apparent at 24 hours and at hospital discharge and how later factors impact outcome.METHODS: All patients enrolled in the German Stroke Registry (June 2015-December 2019) with anterior circulation stroke and availability of baseline data and neurological status were included. A mediation analysis was conducted to investigate the effect of successful recanalization (Thrombolysis in Cerebral Infarction scale score ≥2b) on good functional outcome (modified Rankin Scale score ≤2 at day 90) with mediation through neurological status (National Institutes of Health Stroke Scale [NIHSS] at 24 hours and at hospital discharge).RESULTS: Three thousand fifty-seven patients fulfilled the inclusion criteria, thereof 2589 (85%) with successful recanalization and 1180 (39%) with good functional outcome. In a multivariate logistic regression analysis, probability of good outcome was significantly associated with age (odds ratio [95% CI], 0.95 [0.94-0.96]), prestroke modified Rankin Scale (0.48 [0.42-0.55]), admission-NIHSS (0.96 [0.94-0.98]), 24-hour NIHSS (0.83 [0.81-0.84]), diabetes (0.56 [0.43-0.72]), proximal middle cerebral artery occlusions (0.78 [0.62-0.97]), passes (0.88 [0.82-0.95]), Alberta Stroke Program Early CT Score (1.07 [1.00-1.14]), successful recanalization (2.39 [1.68-3.43]), intracerebral hemorrhage (0.51 [0.35-0.73]), and recurrent strokes (0.54 [0.32-0.92]). Mediation analysis showed a 20 percentage points (95% CI' 17-24 percentage points) increase of probability of good functional outcome after successful recanalization. Fifty-four percent (95% CI' 44%-66%) of the improvement in functional outcome was explained by 24-hour NIHSS and 75% (95% CI' 62%-90%) by NIHSS at hospital discharge.CONCLUSIONS: Fifty-four percent of the improvement in functional outcome after successful recanalization is apparent in NIHSS at 24 hours, 75% in NIHSS at hospital discharge. Other unknown factors not apparent in NIHSS at the 2 time points investigated account for the remaining effect on long term outcome, suggesting, among others, clinical relevance of delayed neurological improvement and deterioration.REGISTRATION: URL: https://www.CLINICALTRIALS: gov; Unique identifier: NCT03356392.",
keywords = "Brain Ischemia, Hospitals, Humans, Patient Discharge, Stroke/etiology, Thrombectomy/adverse effects, Treatment Outcome",
author = "Helge Kniep and Lukas Meyer and Matthias Bechstein and Gabriel Broocks and Helena Guerreiro and {van Horn}, Noel and Caspar Brekenfeld and Fabian Flottmann and Milani Deb-Chatterji and Anna Alegiani and G{\"o}tz Thomalla and Uta Hanning and Jens Fiehler and Susanne Gelli{\ss}en and {German Stroke Registry – Endovascular Treatment (GSR – ET)}",
year = "2022",
month = sep,
doi = "10.1161/STROKEAHA.121.037888",
language = "English",
volume = "53",
pages = "2828--2837",
journal = "STROKE",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "9",

}

RIS

TY - JOUR

T1 - How Much of the Thrombectomy Related Improvement in Functional Outcome Is Already Apparent at 24 Hours and at Hospital Discharge?

AU - Kniep, Helge

AU - Meyer, Lukas

AU - Bechstein, Matthias

AU - Broocks, Gabriel

AU - Guerreiro, Helena

AU - van Horn, Noel

AU - Brekenfeld, Caspar

AU - Flottmann, Fabian

AU - Deb-Chatterji, Milani

AU - Alegiani, Anna

AU - Thomalla, Götz

AU - Hanning, Uta

AU - Fiehler, Jens

AU - Gellißen, Susanne

AU - German Stroke Registry – Endovascular Treatment (GSR – ET)

PY - 2022/9

Y1 - 2022/9

N2 - BACKGROUND: Early neurological status has been described as predictor of functional outcome in patients with anterior circulation stroke after mechanical thrombectomy. It remains unclear to what proportion the improvement of functional outcome at day 90 is already apparent at 24 hours and at hospital discharge and how later factors impact outcome.METHODS: All patients enrolled in the German Stroke Registry (June 2015-December 2019) with anterior circulation stroke and availability of baseline data and neurological status were included. A mediation analysis was conducted to investigate the effect of successful recanalization (Thrombolysis in Cerebral Infarction scale score ≥2b) on good functional outcome (modified Rankin Scale score ≤2 at day 90) with mediation through neurological status (National Institutes of Health Stroke Scale [NIHSS] at 24 hours and at hospital discharge).RESULTS: Three thousand fifty-seven patients fulfilled the inclusion criteria, thereof 2589 (85%) with successful recanalization and 1180 (39%) with good functional outcome. In a multivariate logistic regression analysis, probability of good outcome was significantly associated with age (odds ratio [95% CI], 0.95 [0.94-0.96]), prestroke modified Rankin Scale (0.48 [0.42-0.55]), admission-NIHSS (0.96 [0.94-0.98]), 24-hour NIHSS (0.83 [0.81-0.84]), diabetes (0.56 [0.43-0.72]), proximal middle cerebral artery occlusions (0.78 [0.62-0.97]), passes (0.88 [0.82-0.95]), Alberta Stroke Program Early CT Score (1.07 [1.00-1.14]), successful recanalization (2.39 [1.68-3.43]), intracerebral hemorrhage (0.51 [0.35-0.73]), and recurrent strokes (0.54 [0.32-0.92]). Mediation analysis showed a 20 percentage points (95% CI' 17-24 percentage points) increase of probability of good functional outcome after successful recanalization. Fifty-four percent (95% CI' 44%-66%) of the improvement in functional outcome was explained by 24-hour NIHSS and 75% (95% CI' 62%-90%) by NIHSS at hospital discharge.CONCLUSIONS: Fifty-four percent of the improvement in functional outcome after successful recanalization is apparent in NIHSS at 24 hours, 75% in NIHSS at hospital discharge. Other unknown factors not apparent in NIHSS at the 2 time points investigated account for the remaining effect on long term outcome, suggesting, among others, clinical relevance of delayed neurological improvement and deterioration.REGISTRATION: URL: https://www.CLINICALTRIALS: gov; Unique identifier: NCT03356392.

AB - BACKGROUND: Early neurological status has been described as predictor of functional outcome in patients with anterior circulation stroke after mechanical thrombectomy. It remains unclear to what proportion the improvement of functional outcome at day 90 is already apparent at 24 hours and at hospital discharge and how later factors impact outcome.METHODS: All patients enrolled in the German Stroke Registry (June 2015-December 2019) with anterior circulation stroke and availability of baseline data and neurological status were included. A mediation analysis was conducted to investigate the effect of successful recanalization (Thrombolysis in Cerebral Infarction scale score ≥2b) on good functional outcome (modified Rankin Scale score ≤2 at day 90) with mediation through neurological status (National Institutes of Health Stroke Scale [NIHSS] at 24 hours and at hospital discharge).RESULTS: Three thousand fifty-seven patients fulfilled the inclusion criteria, thereof 2589 (85%) with successful recanalization and 1180 (39%) with good functional outcome. In a multivariate logistic regression analysis, probability of good outcome was significantly associated with age (odds ratio [95% CI], 0.95 [0.94-0.96]), prestroke modified Rankin Scale (0.48 [0.42-0.55]), admission-NIHSS (0.96 [0.94-0.98]), 24-hour NIHSS (0.83 [0.81-0.84]), diabetes (0.56 [0.43-0.72]), proximal middle cerebral artery occlusions (0.78 [0.62-0.97]), passes (0.88 [0.82-0.95]), Alberta Stroke Program Early CT Score (1.07 [1.00-1.14]), successful recanalization (2.39 [1.68-3.43]), intracerebral hemorrhage (0.51 [0.35-0.73]), and recurrent strokes (0.54 [0.32-0.92]). Mediation analysis showed a 20 percentage points (95% CI' 17-24 percentage points) increase of probability of good functional outcome after successful recanalization. Fifty-four percent (95% CI' 44%-66%) of the improvement in functional outcome was explained by 24-hour NIHSS and 75% (95% CI' 62%-90%) by NIHSS at hospital discharge.CONCLUSIONS: Fifty-four percent of the improvement in functional outcome after successful recanalization is apparent in NIHSS at 24 hours, 75% in NIHSS at hospital discharge. Other unknown factors not apparent in NIHSS at the 2 time points investigated account for the remaining effect on long term outcome, suggesting, among others, clinical relevance of delayed neurological improvement and deterioration.REGISTRATION: URL: https://www.CLINICALTRIALS: gov; Unique identifier: NCT03356392.

KW - Brain Ischemia

KW - Hospitals

KW - Humans

KW - Patient Discharge

KW - Stroke/etiology

KW - Thrombectomy/adverse effects

KW - Treatment Outcome

U2 - 10.1161/STROKEAHA.121.037888

DO - 10.1161/STROKEAHA.121.037888

M3 - SCORING: Journal article

C2 - 35549377

VL - 53

SP - 2828

EP - 2837

JO - STROKE

JF - STROKE

SN - 0039-2499

IS - 9

ER -