Predictors of poor clinical outcome despite complete reperfusion in acute ischemic stroke patients
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Predictors of poor clinical outcome despite complete reperfusion in acute ischemic stroke patients. / van Horn, Noel; Kniep, Helge; Leischner, Hannes; McDonough, Rosalie; Deb-Chatterji, Milani; Broocks, Gabriel; Thomalla, Goetz; Brekenfeld, Caspar; Fiehler, Jens; Hanning, Uta; Flottmann, Fabian.
In: J NEUROINTERV SURG, Vol. 13, No. 1, 01.2021, p. 14-18.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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T1 - Predictors of poor clinical outcome despite complete reperfusion in acute ischemic stroke patients
AU - van Horn, Noel
AU - Kniep, Helge
AU - Leischner, Hannes
AU - McDonough, Rosalie
AU - Deb-Chatterji, Milani
AU - Broocks, Gabriel
AU - Thomalla, Goetz
AU - Brekenfeld, Caspar
AU - Fiehler, Jens
AU - Hanning, Uta
AU - Flottmann, Fabian
N1 - © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2021/1
Y1 - 2021/1
N2 - BACKGROUND: In patients suffering from acute ischemic stroke from large vessel occlusion (LVO), mechanical thrombectomy (MT) often leads to successful reperfusion. Only approximately half of these patients have a favorable clinical outcome. Our aim was to determine the prognostic factors associated with poor clinical outcome following complete reperfusion.METHODS: Patients treated with MT for LVO from a prospective single-center stroke registry between July 2015 and April 2019 were screened. Complete reperfusion was defined as Thrombolysis in Cerebral Infarction (TICI) grade 3. A modified Rankin scale at 90 days (mRS90) of 3-6 was defined as 'poor outcome'. A logistic regression analysis was performed with poor outcome as a dependent variable, and baseline clinical data, comorbidities, stroke severity, collateral status, and treatment information as independent variables.RESULTS: 123 patients with complete reperfusion (TICI 3) were included in this study. Poor clinical outcome was observed in 67 (54.5%) of these patients. Multivariable logistic regression analysis identified greater age (adjusted OR 1.10, 95% CI 1.04 to 1.17; p=0.001), higher admission National Institutes of Health Stroke Scale (NIHSS) (OR 1.14, 95% CI 1.02 to 1.28; p=0.024), and lower Alberta Stroke Program Early CT Score (ASPECTS) (OR 0.6, 95% CI 0.4 to 0.84; p=0.007) as independent predictors of poor outcome. Poor outcome was independent of collateral score.CONCLUSION: Poor clinical outcome is observed in a large proportion of acute ischemic stroke patients treated with MT, despite complete reperfusion. In this study, futile recanalization was shown to occur independently of collateral status, but was associated with increasing age and stroke severity.
AB - BACKGROUND: In patients suffering from acute ischemic stroke from large vessel occlusion (LVO), mechanical thrombectomy (MT) often leads to successful reperfusion. Only approximately half of these patients have a favorable clinical outcome. Our aim was to determine the prognostic factors associated with poor clinical outcome following complete reperfusion.METHODS: Patients treated with MT for LVO from a prospective single-center stroke registry between July 2015 and April 2019 were screened. Complete reperfusion was defined as Thrombolysis in Cerebral Infarction (TICI) grade 3. A modified Rankin scale at 90 days (mRS90) of 3-6 was defined as 'poor outcome'. A logistic regression analysis was performed with poor outcome as a dependent variable, and baseline clinical data, comorbidities, stroke severity, collateral status, and treatment information as independent variables.RESULTS: 123 patients with complete reperfusion (TICI 3) were included in this study. Poor clinical outcome was observed in 67 (54.5%) of these patients. Multivariable logistic regression analysis identified greater age (adjusted OR 1.10, 95% CI 1.04 to 1.17; p=0.001), higher admission National Institutes of Health Stroke Scale (NIHSS) (OR 1.14, 95% CI 1.02 to 1.28; p=0.024), and lower Alberta Stroke Program Early CT Score (ASPECTS) (OR 0.6, 95% CI 0.4 to 0.84; p=0.007) as independent predictors of poor outcome. Poor outcome was independent of collateral score.CONCLUSION: Poor clinical outcome is observed in a large proportion of acute ischemic stroke patients treated with MT, despite complete reperfusion. In this study, futile recanalization was shown to occur independently of collateral status, but was associated with increasing age and stroke severity.
U2 - 10.1136/neurintsurg-2020-015889
DO - 10.1136/neurintsurg-2020-015889
M3 - SCORING: Journal article
C2 - 32414889
VL - 13
SP - 14
EP - 18
JO - J NEUROINTERV SURG
JF - J NEUROINTERV SURG
SN - 1759-8478
IS - 1
ER -