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Multicenter Study
. 2016 Mar;8(3):224-9.
doi: 10.1136/neurintsurg-2014-011525. Epub 2015 Jan 6.

Predictors of poor outcome despite recanalization: a multiple regression analysis of the NASA registry

Italo Linfante  1 , Amy K Starosciak  2 , Gail R Walker  3 , Guilherme Dabus  1 , Alicia C Castonguay  4 , Rishi Gupta  5 , Chung-Huan J Sun  5 , Coleman Martin  6 , William E Holloway  6 , Nils Mueller-Kronast  7 , Joey D English  8 , Tim W Malisch  9 , Franklin A Marden  9 , Hormozd Bozorgchami  10 , Andrew Xavier  11 , Ansaar T Rai  12 , Michael T Froehler  13 , Aamir Badruddin  14 , Thanh N Nguyen  15 , M Asif Taqi  6 , Michael G Abraham  16 , Vallabh Janardhan  17 , Hashem Shaltoni  18 , Roberta Novakovic  19 , Albert J Yoo  20 , Alex Abou-Chebl  21 , Peng R Chen  22 , Gavin W Britz  23 , Ritesh Kaushal  24 , Ashish Nanda  25 , Mohammad A Issa  4 , Raul G Nogueira  5 , Osama O Zaidat  4
Affiliations
Multicenter Study

Predictors of poor outcome despite recanalization: a multiple regression analysis of the NASA registry

Italo Linfante et al. J Neurointerv Surg. 2016 Mar.

Abstract

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.

Keywords: Angiography; Intervention; Stroke; Thrombectomy.

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