RT Journal Article
SR Electronic
T1 What predicts poor outcome after successful thrombectomy in late time windows?
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 421
OP 425
DO 10.1136/neurintsurg-2020-016125
VO 13
IS 5
A1 Jeremy J Heit
A1 Michael Mlynash
A1 Soren Christensen
A1 Stephanie M Kemp
A1 Maarten G Lansberg
A1 Michael P Marks
A1 Jean-Marc Olivot
A1 Albers W Gregory
YR 2021
UL http://jnis.bmj.com/content/13/5/421.abstract
AB 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 are available from the corresponding author upon reasonable request.