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. 2023 Oct 31;13(1):18740.
doi: 10.1038/s41598-023-45232-x.

Predictors of functional outcome after thrombectomy for M2 occlusions: a large scale experience from clinical practice

Helge Kniep  1 , Lukas Meyer  2 , Gabriel Broocks  2 , Matthias Bechstein  2 , Helena Guerreiro  2 , Laurens Winkelmeier  2 , Caspar Brekenfeld  2 , Fabian Flottmann  2 , Milani Deb-Chatterji  3 , Anna Alegiani  3   4 , Uta Hanning  2 , Götz Thomalla  3 , Jens Fiehler  2 , Susanne Gellißen  2 ; German Stroke Registry – Endovascular Treatment (GSR – ET)
Collaborators, Affiliations

Predictors of functional outcome after thrombectomy for M2 occlusions: a large scale experience from clinical practice

Helge Kniep et al. Sci Rep. .

Abstract

Mechanical thrombectomy (MT) for acute ischemic stroke with medium vessel occlusions is still a matter of debate. We sought to identify factors associated with clinical outcome after MT for M2-occlusions based on data from the German Stroke Registry-Endovascular Treatment (GSR-ET). All patients prospectively enrolled in the GSR-ET from 05/2015 to 12/2021 were analyzed (NCT03356392). Inclusion criteria were primary M2-occlusions and availability of relevant clinical data. Factors associated with excellent/good outcome (modified Rankin scale mRS 0-1/0-2), poor outcome/death (mRS 5-6) and mRS-increase pre-stroke to day 90 were determined in multivariable logistic regression. 1348 patients were included. 1128(84%) had successful recanalization, 595(44%) achieved good outcome, 402 (30%) had poor outcome. Successful recanalization (odds ratio [OR] 4.27 [95% confidence interval 3.12-5.91], p < 0.001), higher Alberta stroke program early CT score (OR 1.25 [1.18-1.32], p < 0.001) and i.v. thrombolysis (OR 1.28 [1.07-1.54], p < 0.01) increased probability of good outcome, while age (OR 0.95 [0.94-0.95], p < 0.001), higher pre-stroke-mRS (OR 0.36 [0.31-0.40], p < 0.001), higher baseline NIHSS (OR 0.89 [0.88-0.91], p < 0.001), diabetes (OR 0.52 [0.42-0.64], p < 0.001), higher number of passes (OR 0.75 [0.70-0.80], p < 0.001) and intracranial hemorrhage (OR 0.26 [0.14-0.46], p < 0.001) decreased the probability of good outcome. Additional predictors of mRS-increase pre-stroke to 90d were dissections, perforations (OR 1.59 [1.11-2.29], p < 0.05) and clot migration, embolization (OR 1.67 [1.21-2.30], p < 0.01). Corresponding to large-vessel-occlusions, younger age, low pre-stroke-mRS, low severity of acute clinical disability, i.v. thrombolysis and successful recanalization were associated with good outcome while diabetes and higher number of passes decreased probability of good outcome after MT in M2 occlusions. Treatment related complications increased probability of mRS increase pre-stroke to 90d.

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Conflict of interest statement

Helge Kniep and Fabian Flottmann are consultants for Eppdata GmbH. Helge Kniep is shareholder of Eppdata GmbH. Milani Deb-Chatterji has received research grants from the Werner Otto Stiftung and serves in the advisory board of the PRECIOUS Trial. Götz Thomalla received fees as consultant from Acandis, Boehringer Ingelheim, Bayer, and Portola, and fees as lecturer from Acandis, Alexion, Amarin, Bayer, Boehringer-Ingelheim, BMS/Pfizer, Daiichii Sankyo and Portola. He serves in the board of the TEA Stroke Study and of ESO. Jens Fiehler is consultant for Cerenovus, Medtronic, Microvention, Penumbra, Phenox, Roche and Tonbridge. He serves in the advisory board of Stryker and Phenox. He is stock holder of Tegus Medical, Eppdata and Vastrax. He serves as Associate Editor at JNIS. All other authors have nothing to declare.

Figures

Figure 1
Figure 1
Patient inclusion flow chart. ASPECTS: Alberta Stroke Program Early CT Score, GSR-ET: German Stroke Registry-Endovascular Treatment, mRS: modified Rankin Scale, TICI: modified Thrombolysis in cerebral infarction.
Figure 2
Figure 2
Predictors of excellent, good and poor functional outcome after thrombectomy for M2 occlusions, multivariable logistic regression analysis. AE: Adverse events, ASPECTS: Alberta Stroke Program Early CT Score, CI: Confidence interval, mRS: modified Rankin Scale, NIHSS: National Institute of Health Stroke Scale, OR: Odds ratio, TICI: modified Thrombolysis in cerebral infarction.
Figure 3
Figure 3
Predictors of mRS increase pre-stroke to 90d after thrombectomy for M2 occlusions, multivariable ordinal logistic regression analysis. AE: Adverse events, ASPECTS: Alberta Stroke Program Early CT Score, CI: Confidence interval, mRS: modified Rankin Scale, NIHSS: National Institute of Health Stroke Scale, OR: Odds ratio, TICI: modified Thrombolysis in cerebral infarction.
Figure 4
Figure 4
Probability of good outcome depending on recanalization status and i.v. thrombolysis in multivariable logistic regression analysis. All analysis were controlled for Age, pre-mRS, Diabetes, ASPECTS and number of passes. NIHSS: National Institute of Health Stroke Scale, mRS: modified Rankin Scale, TICI: modified Thrombolysis in cerebral infarction.
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References

    1. Goyal M, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: A meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):1723–1731. doi: 10.1016/S0140-6736(16)00163-X. - DOI - PubMed
    1. Powers WJ, et al. 2018 guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018;49(3):e46–e110. doi: 10.1161/STR.0000000000000158. - DOI - PubMed
    1. Saver JL, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N. Engl. J. Med. 2015;372(24):2285–95. doi: 10.1056/NEJMoa1415061. - DOI - PubMed
    1. Menon BK, et al. Efficacy of endovascular thrombectomy in patients with M2 segment middle cerebral artery occlusions: Meta-analysis of data from the HERMES Collaboration. J. Neurointerv. Surg. 2019;11(11):1065–1069. doi: 10.1136/neurintsurg-2018-014678. - DOI - PubMed
    1. Tian H, et al. Influence of occlusion site and baseline ischemic core on outcome in patients with ischemic stroke. Neurology. 2019;92(23):e2626–e2643. doi: 10.1212/WNL.0000000000007553. - DOI - PubMed

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