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. 2021 Jan;13(1):14-18.
doi: 10.1136/neurintsurg-2020-015889. Epub 2020 May 15.

Predictors of poor clinical outcome despite complete reperfusion in acute ischemic stroke patients

Noel van Horn  1 , Helge Kniep  2 , Hannes Leischner  2 , Rosalie McDonough  2 , Milani Deb-Chatterji  3 , Gabriel Broocks  2 , Goetz Thomalla  3 , Caspar Brekenfeld  2 , Jens Fiehler  2 , Uta Hanning #  2 , Fabian Flottmann #  2
Affiliations

Predictors of poor clinical outcome despite complete reperfusion in acute ischemic stroke patients

Noel van Horn et al. J Neurointerv Surg. 2021 Jan.

Abstract

Background: In patients suffering from acute ischemic stroke from large vessel occlusion (LVO), mechanical thrombectomy (MT) often leads to successful reperfusion. Only approximately half of these patients have a favorable clinical outcome. Our aim was to determine the prognostic factors associated with poor clinical outcome following complete reperfusion.

Methods: Patients treated with MT for LVO from a prospective single-center stroke registry between July 2015 and April 2019 were screened. Complete reperfusion was defined as Thrombolysis in Cerebral Infarction (TICI) grade 3. A modified Rankin scale at 90 days (mRS90) of 3-6 was defined as 'poor outcome'. A logistic regression analysis was performed with poor outcome as a dependent variable, and baseline clinical data, comorbidities, stroke severity, collateral status, and treatment information as independent variables.

Results: 123 patients with complete reperfusion (TICI 3) were included in this study. Poor clinical outcome was observed in 67 (54.5%) of these patients. Multivariable logistic regression analysis identified greater age (adjusted OR 1.10, 95% CI 1.04 to 1.17; p=0.001), higher admission National Institutes of Health Stroke Scale (NIHSS) (OR 1.14, 95% CI 1.02 to 1.28; p=0.024), and lower Alberta Stroke Program Early CT Score (ASPECTS) (OR 0.6, 95% CI 0.4 to 0.84; p=0.007) as independent predictors of poor outcome. Poor outcome was independent of collateral score.

Conclusion: Poor clinical outcome is observed in a large proportion of acute ischemic stroke patients treated with MT, despite complete reperfusion. In this study, futile recanalization was shown to occur independently of collateral status, but was associated with increasing age and stroke severity.

Keywords: intervention; stroke; thrombectomy.

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Conflict of interest statement

Competing interests: JF: Consultant for Acandis, Boehringer Ingelheim, Codman, Microvention, Sequent, Stryker. Speaker for Bayer Healthcare, Bracco, Covidien/ev3, Penumbra, Philips, Siemens. Grants from Bundesministeriums für Wirtschaft und Energie (BMWi), Bundesministerium für Bildung und Forschung (BMBF), Deutsche Forschungsgemeinschaft (DFG), European Union (EU), Covidien, Stryker (THRILL study), Microvention (ERASER study), Philips. GT: Consulting fees from Acandis, grant support and lecture fees from Bayer, lecture fees from Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, and Daiichi Sankyo, and consulting fees and lecture fees from Stryker. Grants from Bundesministerium für Wirtschaft und Energie (BMWi), Deutsche Forschungsgemeinschaft (DFG), European Union (EU), German Innovation Fund, Corona Foundation.

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