Background Thrombectomy for acute ischemic stroke treatment leads to improved outcomes, but many patients do not achieve a good outcome despite successful reperfusion. We determined predictors of poor outcome after successful thrombectomy (TICI 2b–3) with an emphasis on modifiable factors.
Methods Patients from the randomized DEFUSE 3 trial who underwent thrombectomy with TICI 2b–3 revascularization were included. Primary outcome was a poor outcome at 90 days (modified Rankin Scale score 3–6).
Results 70 patients were included. Poor outcome patients were older (73.5 vs 66.5 years; P=0.01), more likely to be female (68% vs 39%; P=0.02), had higher NIHSS scores (20 vs 13; P<0.001), and had poor cerebral perfusion collaterals (hypoperfusion intensity ratio) (median 0.45 vs 0.38; P=0.03). Following thrombectomy, poor outcome patients had larger 24 hour’ core infarctions (median 59.5 vs 29.9 mL; P=0.01), more core infarction growth (median 33.6 vs 13.4 mL; P<0.001), and more mild (65% vs 50%; P=0.02) and severe (18% vs 0%; P=0.01) reperfusion hemorrhage. In a logistic regression analysis, the presence of any reperfusion hemorrhage (OR 3.3 [95% CI, 1.67 to 5]; P=0.001), age (OR 1.1 [95% CI, 1.03 to 1.11], P=0.004), higher NIHSS (OR 1.25 [95% CI, 1.07 to 1.41], P=0.002), and time from imaging to femoral artery puncture (OR 5 [95% CI, 1.16 to 16.67], P=0.03) independently predicted poor outcomes.
Conclusions In late time windows, both mild and severe reperfusion hemorrhage were associated with poor outcomes. Older age, higher NIHSS, and increased time from imaging to arterial puncture were also associated with poor outcomes despite successful revascularization.
Trial registration https://clinicaltrials.gov/ct2/show/NCT02586415
Data availability statement
Data are available from the corresponding author upon reasonable request.
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Contributors JJH, GWA, MPM, and MGL conceived of the study idea. SC, MM, and SMK performed data collection and analysis. All authors participated in critical revisions of the manuscript.
Funding Funding was provided by grants from the National Institutes of Neurological Disorders and Stroke and StrokeNet (U10NS086487 and U01NS092076).
Competing interests JJH: Medtronic (consulting); MicroVention (consulting), iSchemaView, Inc (Medical and Scientific Advisory Board) SC: iSchemaView, Inc (equity and consulting) MGL: Novo Nordisk, Genentech/Roche, Biogen and Moleac. Principal investigator on NIH and Neofect research grants. MPM: ThrombX Medical, Inc (ownership interest). AWG: iSchemaView, Inc (equity and consulting); Medtronic (consulting).
Provenance and peer review Not commissioned; externally peer reviewed.