Background The absence of the susceptibility vessel sign (SVS) in patients treated with mechanical thrombectomy (MT) is associated with poor radiological and clinical outcomes after 3 months. Underlying conditions, such as cancer, are assumed to influence SVS status and could potentially impact the long-term outcome. We aimed to assess SVS status as an independent predictor of long-term outcomes in MT-treated patients.
Methods SVS status was retrospectively determined in consecutive MT-treated patients at a comprehensive stroke center between 2010 and 2018. Predictors of long-term mortality and poor functional outcome (modified Rankin Scale (mRS) ≥3) up to 8 years were identified using multivariable Cox and logistic regression, respectively.
Results Of the 558 patients included, SVS was absent in 13% (n=71) and present in 87% (n=487) on baseline imaging. Patients without SVS were more likely to have active cancer (P=0.003) and diabetes mellitus (P<0.001) at the time of stroke. The median long-term follow-up time was 1058 days (IQR 533–1671 days). After adjustment for active cancer and diabetes mellitus, among others, the absence of SVS was associated with long-term mortality (adjusted HR (aHR) 2.11, 95% CI 1.35 to 3.29) and poor functional outcome in the long term (adjusted OR (aOR) 2.90, 95% CI 1.29 to 6.55).
Conclusion MT-treated patients without SVS have higher long-term mortality rates and poorer long-term functional outcome. It appears that this association cannot be explained by comorbidities alone, and further studies are warranted.
Data availability statement
Data are available upon reasonable request.
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JK and AM contributed equally.
Contributors MB: conception and design, data acquisition, analysis and interpretation of data, and writing of the manuscript. ER: data acquisition and critical revision of the manuscript for important intellectual content. LW: data acquisition and critical revision of the manuscript for important intellectual content. CCK: data acquisition and critical revision of the manuscript for important intellectual content. EIIP: data acquisition and critical revision of the manuscript for important intellectual content. UF: conception and design, critical revision of the manuscript for important intellectual content. JK: conception and design, analysis and interpretation of data, writing of the manuscript, critical revision of the manuscript for important intellectual content, and supervision. AM: conception and design, interpretation of data, critical revision of the manuscript for important intellectual content, supervision and action as the guarantor of the study. All other authors contributed to critical revision of the manuscript for important intellectual content.
Funding This work was supported by grants provided by the Kurt und Senta Hermann-Stiftung (grant number WNK-228), by the Swiss Academy of Medical Sciences (SAMS) within the framework of the Young Talents in Clinical Research Program (grant number YTCR 03/19) and grants from the Clinical Trials Unit Bern, University of Bern (grant number 84801869).
Competing interests MB reports research support from the Kurt und Senta Hermann-Stiftung. JK reports grants from the Swiss Academy of Medical Sciences/Bangerter Foundation, Swiss Stroke Society, and Clinical Trials Unit Bern during the conduct of the study. UF reports grants during the conduct of the study from Medtronic, Stryker, and CSL Behring, unrelated to the submitted work. JG is a global principal investigator of STAR (Solitaire FR Thrombectomy for Acute Revascularisation), Clinical Event Committee member of the PROMISE study (Prospective, Multicenter, Observational, Single-Arm European Registry on the ACE Reperfusion Catheters and the Penumbra System in the Treatment of Acute Ischemic Stroke; Penumbra), and a principal investigator and consultant for the SWIFT DIRECT study (Solitaire With the Intention for Thrombectomy Plus Intravenous tPA Versus DIRECT Solitaire Stent-Retriever Thrombectomy in Acute Anterior Circulation Stroke; Medtronic) and receives Swiss National Science Foundation grants for magnetic resonance imaging in stroke. MA reports personal fees from Bayer, Bristol-Myers Squibb, Medtronic, Amgen, Daiichi Sankyo, Nestlé Health Sciences, Boehringer Ingelheim, and Covidien during the conduct of the study. TRM reports research support from the Bangerter Rhyner Foundation, Swiss National Foundation, and the Swiss Heart Foundation. SJ reports grants from the Swiss National Science Foundation and the Swiss Heart Foundation. EIIP reports grants from the Swiss National Science Foundation. MRH reports grants from Swiss National Science Foundation, SITEM Research Support Funds and Swiss Heart Foundation, not directly related to this manuscript.
Provenance and peer review Not commissioned; externally peer reviewed.
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