Article Text

PDF
O-032 Predictors of Poor Outcomes Despite Successful Recanalization in Patients with Acute Ischemic Stroke
  1. I Linfante1,
  2. G Dabus1,
  3. A Starosciak1,
  4. A Castonguay2,
  5. R Gupta3,
  6. C Sun3,
  7. C Martin4,
  8. W Holloway4,
  9. N Mueller-Kronast5,
  10. J English6,
  11. T Malisch7,
  12. F Marden7,
  13. H Bozorgchami8,
  14. A Xavier9,
  15. A Rai10,
  16. M Froehler11,
  17. A Badruddin12,
  18. T Nguyen13,
  19. M Taqi14,
  20. M Abraham15,
  21. V Janardhan16,
  22. H Shaltoni17,
  23. R Novakovic18,
  24. A Yoo19,
  25. O Zaidat20
  1. 1Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL, USA
  2. 2Neurology, Medical College of Wisconsin/Froedtert Hospital, Milwaukee, WI, USA
  3. 3Neurology, Emory University School of Medicine, Atlanta, GA, USA
  4. 4St Luke’s Kansas City, Kansas City, MO, USA
  5. 5Neurology, Delray Medical Center, Delray Beach, FL, USA
  6. 6California Pacific Medical Center, San Francisco, CA, USA
  7. 7Alexian Brothers Medical Center, Elk Grove Village, IL, USA
  8. 8Oregon Health and Science University, Portland, OR, USA
  9. 9Neurology, Wayne State University School of Medicine, Detroit, MI, USA
  10. 10Radiology, West Virginia University Hospital, Morgantown, WV, USA
  11. 11Neurology, Neurosurgery, and Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
  12. 12Provena Saint Joseph Medical Center, Joliet, IL, USA
  13. 13Neurology, Neurosurgery, and Radiology, Boston Medical Center, Boston, MA, USA
  14. 14Desert Regional Medical Center, Palm Springs, CA, USA
  15. 15University of Kansas Medical Center, Kansas City, KS, USA
  16. 16Texas Stroke Institute, Plano, TX, USA
  17. 17University of Texas Health Science Center, Houston, TX, USA
  18. 18Radiology and Neurology, UT Southwestern Medical Center, Dallas, TX, USA
  19. 19Radiology, Division of Diagnostic and Interventional Neuroradiology, Massachusetts General Hospital, Boston, MA, USA
  20. 20Neurology, Neurosurgery, Radiology, Medical College of Wisconsin/Froedtert Hospital, Milwaukee, WI, USA

Abstract

Background Recanalization of the occluded artery is a powerful predictor of good outcome in acute ischemic stroke secondary to large artery occlusions. Mechanical thrombectomy with stent-trievers results in higher recanalization rates and better outcomes compared to previous devices. However, despite successful recanalization rates (Treatment in Cerebral Infarction, TICI, score ≥ 2b) between 70 and 90%, good clinical outcomes assessed by modified Rankin Scale (mRS ≥ 2 is present in 40–50% of patients. We aimed to evaluate predictors of poor outcomes (mRS ≥ 2) despite successful recanalization (TICI ≥ 2b) in the acute stroke patients treated with the Solitaire device of the North American Solitaire Stent Retriever Acute Stroke (NASA) registry.

Methods The NASA registry is a multicenter, non-sponsored, physician-conducted, post-marketing registry on the use of SOLITAIRE FR device in 354 acute, large vessels, ischemic stroke patients. Logistic regression was used to evaluate patient characteristics and treatment parameters for association with 90-day mRS score of 0–2 (good outcome) versus 3–6 (poor outcome) within patients who were recanalised successfully (Thrombolysis in Cerebral Infarction or TICI score 2b-3). Univariate tests were followed by development of a multivariable model based on stepwise selection with entry and retention criteria of p < 0.05 from the set of factors with at least marginal significance (p ≤ 0.10) on univariate analysis. The c-statistic was calculated as a measure of predictive power.

Results Out of 354 patients, 256 (72.3%) were successfully recanalised (TICI ≥ 2b). Based on 90-day mRS score for 234 of these patients, there were 116 (49.6%) with mRS ≥2. Univariate analysis identified increased risk of mRS ≥2 for each of the following: age ≥ 80 years (upper quartile of data), occlusion site other than M1/M2, NIH Stroke Scale (NIHSS) score ≥ 18 (median), history of diabetes mellitus (DM), TICI = 2b, use of rescue therapy, not using a balloon-guided catheter (BCG) or intravenous tissue plasminogen activator (IV t-PA), and time to recanalization > 30 min (all p ≤ 0.05). Three or more passes was marginally significant (p = 0.097). In multivariable analysis, age ≥80 years, site other than M1/M2, initial NIHSS ≥18, DM, absence of IVtPA, use of rescue therapy and three or more passes were significant independent predictors of poor 90-day outcome in a model with good predictive power (c-index = 0.80).

Conclusions Age, occlusion site, high NIHSS, diabetes, not receiving IVtPA, use of rescue therapy and three or more passes, were associated with poor 90-day outcome despite successful recanalization.

Disclosures I. Linfante: None. G. Dabus: None. A. Starosciak: None. A. Castonguay: None. R. Gupta: None. C. Sun: None. C. Martin: None. W. Holloway: None. N. Mueller-Kronast: None. J. English: None. T. Malisch: None. F. Marden: None. H. Bozorgchami: None. A. Xavier: None. A. Rai: None. M. Froehler: None. A. Badruddin: None. T. Nguyen: None. M. Taqi: None. M. Abraham: None. V. Janardhan: None. H. Shaltoni: None. R. Novakovic: None. A. Yoo: None. O. Zaidat: None.

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.