RT Journal Article
SR Electronic
T1 Predictors of poor outcome despite recanalization: a multiple regression analysis of the NASA registry
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 224
OP 229
DO 10.1136/neurintsurg-2014-011525
VO 8
IS 3
A1 Linfante, Italo
A1 Starosciak, Amy K
A1 Walker, Gail R
A1 Dabus, Guilherme
A1 Castonguay, Alicia C
A1 Gupta, Rishi
A1 Sun, Chung-Huan J
A1 Martin, Coleman
A1 Holloway, William E
A1 Mueller-Kronast, Nils
A1 English, Joey D
A1 Malisch, Tim W
A1 Marden, Franklin A
A1 Bozorgchami, Hormozd
A1 Xavier, Andrew
A1 Rai, Ansaar T
A1 Froehler, Michael T
A1 Badruddin, Aamir
A1 Nguyen, Thanh N
A1 Taqi, M Asif
A1 Abraham, Michael G
A1 Janardhan, Vallabh
A1 Shaltoni, Hashem
A1 Novakovic, Roberta
A1 Yoo, Albert J
A1 Abou-Chebl, Alex
A1 Chen, Peng R
A1 Britz, Gavin W
A1 Kaushal, Ritesh
A1 Nanda, Ashish
A1 Issa, Mohammad A
A1 Nogueira, Raul G
A1 Zaidat, Osama O
YR 2016
UL http://jnis.bmj.com/content/8/3/224.abstract
AB Background Mechanical thrombectomy with stent-retrievers results in higher recanalization rates compared with previous devices. Despite successful recanalization rates (Thrombolysis in Cerebral Infarction (TICI) score ≥2b) of 70–83%, good outcomes by 90-day modified Rankin Scale (mRS) score ≤2 are achieved in only 40–55% of patients. We evaluated predictors of poor outcomes (mRS >2) despite successful recanalization (TICI ≥2b) in the North American Solitaire Stent Retriever Acute Stroke (NASA) registry.Methods Logistic regression was used to evaluate baseline characteristics and recanalization outcomes for association with 90-day mRS score of 0–2 (good outcome) vs 3–6 (poor outcome). Univariate tests were carried out for all factors. A multivariable model was developed based on backwards selection from the factors with at least marginal significance (p≤0.10) on univariate analysis with the retention criterion set at p≤0.05. The model was refit to minimize the number of cases excluded because of missing covariate values; the c-statistic was a measure of predictive power.Results Of 354 patients, 256 (72.3%) were recanalized successfully. Based on 234 recanalized patients evaluated for 90-day mRS score, 116 (49.6%) had poor outcomes. Univariate analysis identified an increased risk of poor outcome for age ≥80 years, occlusion site of internal carotid artery (ICA)/basilar artery, National Institute of Health Stroke Scale (NIHSS) score ≥18, history of diabetes mellitus, TICI 2b, use of rescue therapy, not using a balloon-guided catheter or intravenous tissue plasminogen activator (IV t-PA), and >30 min to recanalization (p≤0.05). In multivariable analysis, age ≥80 years, occlusion site ICA/basilar, initial NIHSS score ≥18, diabetes, absence of IV t-PA, ≥3 passes, and use of rescue therapy 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, no IV t-PA, ≥3 passes, and use of rescue therapy are associated with poor 90-day outcome despite successful recanalization.