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Observational Study
. 2023 Mar;8(1):215-223.
doi: 10.1177/23969873221143210. Epub 2022 Dec 14.

Timing and causes of death after endovascular thrombectomy in patients with acute ischemic stroke

Wouter M Sluis  1 , Wouter H Hinsenveld  2 , Robert-Jan B Goldhoorn  2 , Lianne H Potters  1 , Agnetha Ae Bruggeman  3 , Anouk van der Hoorn  4 , Joseph Cj Bot  5 , Robert J van Oostenbrugge  2 , Hester F Lingsma  6 , Jeannette Hofmeijer  7 , Wim H van Zwam  8 , Charles Blm Majoie  3 , H Bart van der Worp  1
Affiliations
Observational Study

Timing and causes of death after endovascular thrombectomy in patients with acute ischemic stroke

Wouter M Sluis et al. Eur Stroke J. 2023 Mar.

Abstract

Introduction: Endovascular thrombectomy (EVT) increases the chance of good functional outcome after ischemic stroke caused by a large vessel occlusion, but the risk of death in the first 90 days is still considerable. We assessed the causes, timing and risk factors of death after EVT to aid future studies aiming to reduce mortality.

Patients and methods: We used data from the MR CLEAN Registry, a prospective, multicenter, observational cohort study of patients treated with EVT in the Netherlands between March 2014, and November 2017. We assessed causes and timing of death and risk factors for death in the first 90 days after treatment. Causes and timing of death were determined by reviewing serious adverse event forms, discharge letters, or other written clinical information. Risk factors for death were determined with multivariable logistic regression.

Results: Of 3180 patients treated with EVT, 863 (27.1%) died in the first 90 days. The most common causes of death were pneumonia (215 patients, 26.2%), intracranial hemorrhage (142 patients, 17.3%), withdrawal of life-sustaining treatment because of the initial stroke (110 patients, 13.4%) and space-occupying edema (101 patients, 12.3%). In total, 448 patients (52% of all deaths) died in the first week, with intracranial hemorrhage as most frequent cause. The strongest risk factors for death were hyperglycemia and functional dependency before the stroke and severe neurological deficit at 24-48 h after treatment.

Discussion and conclusion: When EVT fails to decrease the initial neurological deficit, strategies to prevent complications like pneumonia and intracranial hemorrhage after EVT could improve survival, as these are often the cause of death.

Keywords: Stroke; death; endovascular treatment; intracerebral hemorrhage; ischemic stroke; malignant infarction; mortality; pneumonia; space-occupying edema; thrombectomy.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: WMS is supported by the European Union’s Horizon 2020 research and innovation program (634809). CBLMM received funds from TWIN Foundation (related to this project, paid to institution), CVON/Dutch Heart Foundation, Stryker, European Commission, Healthcare Evaluation Netherlands (unrelated to this project; paid to institution) and is shareholder of Nicolab. HBvdW has received speaker’s fees from Bayer and Boehringer Ingelheim; served as a consultant to Bayer, Boehringer Ingelheim, and LivaNova; and reports grants from Stryker.

Figures

Figure 1.
Figure 1.
Most frequent causes of death in the first 7 days. ICH: intracranial hemorrhage.
Figure 2.
Figure 2.
Most frequent causes of death within 90 days. ICH: intracranial hemorrhage.
See this image and copyright information in PMC

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