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E-036 age, stroke severity, use of stent retrievers, general anesthesia, and hemorrhagic conversion may predict outcome in stroke patients who undergo successful intra-arterial therapy
  1. M Noufal,
  2. J Mankad,
  3. D Shirilla,
  4. A Lakraj,
  5. J Cox,
  6. A Sattar,
  7. W Wally,
  8. Y Sallowm,
  9. J Lynch,
  10. O Zaidat
  1. Neurology, Medical College of Wisconsin, Milwaukee, WI, USA

Abstract

Background Early intra-arterial therapy achieves good functional outcome in 32%–70% of patients with acute ischemic stroke due to large vessel occlusion. While timely recanalization has been shown to be the prototype predictor for good outcome, other factors that might affect recovery in those patients are not well documented.

Method A single center database review identified stroke patients who underwent intra-arterial therapy with successful final recanalization defined as TICI 3 or TICI 2b. Demographic, clinical, radiographic, and procedural variables of these patients were included in logistic statistical analysis using t-test and Chi-square test to study their effects on functional outcome as described by mRS score at 3 months.

Results Out of 296 patients treated with intra-arterial therapy, 129 (43.5%) had successful recanalization and were included in our analysis. Of those patients, 68 (52.7%) had good functional outcome defined as mRS 0–2, and 55 (42.6%) had poor outcome (mRS >2). Six patients were lost to follow-up.

Mean age of the patients was 63 years, and mean NIHSS score was 16. Onset to groin puncture average time was 352 min, while the mean procedure duration was 108 min.

When compared to those who had poor outcome, patients who had good functional outcome were younger (mean age 59 years compared to 66 years, p 0.0116), and had less severe stroke (mean NIHSS score 13 compared to 19, p < 0.0001). Employment of stent retrievers was associated with good outcome (p 0.036), while general anesthesia and symptomatic intracerebral hemorrhage were associated with poor outcome (p 0.01, and 0.005, respectively).

On multivariate analysis; age (p 0.001), NIHSS score (p < 0.0001), and use of stent retrievers (p 0.0264) remained as independent predictors for good outcome, whereas general anesthesia (p 0.005) and symptomatic intracerebral hemorrhage (p 0.0002) independently predicted poor outcome. Of note, patients who underwent general anesthesia (N51) had slightly, yet statistically significant, more severe stroke (mean NIHSS score 18 compared to 15, p 0.039).

Conclusion Age, NIHSS score, use of stent retrievers, mode of anesthesia, and symptomatic ICH might affect functional outcome in stroke patients who achieve successful recanalization via intra-arterial therapy. Prospective studies, or a meta-analysis of sub-groups in the recently published prospective trials are needed to confirm the association between those factors, or others, and functional outcome. Identification of such predictors might help in screening acute stroke patients for intra-arterial therapy.

Disclosures M. Noufal: None. J. Mankad: None. D. Shirilla: None. A. Lakraj: None. J. Cox: None. A. Sattar: None. W. Wally: None. Y. Sallowm: None. J. Lynch: None. O. Zaidat: None.

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