Article Text

Download PDFPDF
Original research
Prediction of death after endovascular thrombectomy in the extended window: a secondary analysis of DEFUSE 3 "
  1. Philipp Taussky1,
  2. Guilherme Agnoletto1,
  3. Ramesh Grandhi1,
  4. Matthew D Alexander2,
  5. Ka-Ho Wong3,
  6. Gregory W Albers4,
  7. Adam de Havenon3
  1. 1 Department of Neurosurgery, University of Utah Health, Salt Lake City, Utah, USA
  2. 2 Radiology and Biomedical Imaging, University of Utah Health, Salt Lake City, Utah, USA
  3. 3 Department of Neurology, University of Utah Health, Salt Lake City, Utah, USA
  4. 4 Department of Neurology, Stanford University, Stanford, California, USA
  1. Correspondence to Dr Philipp Taussky, Department of Neurosurgery, University of Utah Health, Salt Lake City, UT 84132, USA; phil.taussky{at}hsc.utah.edu

Abstract

Background The Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3 (DEFUSE 3) clinical trial assessed the use of endovascular thrombectomy (EVT) during the period 6–16 hours after last normal in selected patients. This is a secondary cohort analysis of the DEFUSE 3 data assessing potential predictive variables for mortality in the EVT-treated patients.

Methods The primary outcome was death within 90 days. Patients who died and those who did not were compared statistically. We developed a predictive score using preprocedural variables that were statistically predictive of death in univariate regression analysis (P<0.1).

Results Of the 182 patients in the DEFUSE 3 study, 92 (mean age 69 years; 50% male) met our inclusion criteria, and 15.2% of these patients met the primary outcome. Patient age, baseline National Institutes of Health Stroke Scale (NIHSS) score, wake-up stroke, statin use, and history of diabetes were statistically associated with death. Statin use did not improve the prediction score so was excluded. Thus, our model included four predictors, with one point each given for age >75 years, NIHSS ≥20, wake-up stroke, and diabetes, yielding low (0–1), moderate (2), and high (3–4) risk of death. In the low-risk, moderate-risk, and high-risk categories, 2/52 (3.9%), 3/23 (13.0%), and 9/17 (52.9%) of patients died, respectively (P<0.001).

Conclusions Despite selective inclusion criteria and overwhelming benefit for EVT, a substantial number of EVT patients in DEFUSE 3 died. The preprocedural variables age, NIHSS, wake-up stroke, and diabetes may predict this risk. Our predictive score provides a basis for future research to determine which factors influence lethal outcome after EVT.

  • stroke
  • thrombectomy

Data availability statement

Data are available in a public, open access repository. The study used publicly available data from the DEFUSE 3 trial obtained from the National Institute of Neurologic Disorders and Stroke (https://www.ninds.nih.gov/Current-Research/Research-Funded-NINDS/Clinical-Research/Archived-Clinical-Research-Datasets).

Statistics from Altmetric.com

Data availability statement

Data are available in a public, open access repository. The study used publicly available data from the DEFUSE 3 trial obtained from the National Institute of Neurologic Disorders and Stroke (https://www.ninds.nih.gov/Current-Research/Research-Funded-NINDS/Clinical-Research/Archived-Clinical-Research-Datasets).

View Full Text

Footnotes

  • Contributors PT: study conception, data analysis, manuscript writing, manuscript revision; GA: manuscript writing, manuscript revision; RG: manuscript writing, manuscript revision; MDA: manuscript writing, manuscript revision; K-HW: data analysis, manuscript revision; GWA: designed data collection tool, data acquisition, manuscript revision; AdH: study conception, designed data collection tool, monitored data collection, planned statistical analysis, data analysis, manuscript writing, manuscript revision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests PT is a consultant for Covidien, Medtronic, and Stryker Neurovascular. RG is a consultant for Balt Neurovascular, Cerenovus, and Medtronic Neurovascular. GWA is supported by grants from the National Institutes of Health (NIH), is a consultant for Genentech, and a shareholder and consultant for iSchemaView. AdH is supported by NIH-NINDS K23NS105924 and receives investigator-initiated funding from AMAG and Regeneron pharmaceuticals for clinical research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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.