Predictive outcome of late window ischemic stroke patients following endovascular therapy: a multi-center study

Abstract

Background and purpose: Stroke is a leading cause of morbidity and mortality worldwide. Endovascular therapy (EVT) has been established as a gold standard option to treat acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) presenting within 6 h of symptom onset. However, there is a paucity of information regarding patient outcome and mortality in patients presenting in late time window within 6 to 24 h. In this study, we aimed to assess for predictors of outcomes in late window stroke patients following EVT.

Methods: We analyzed data from 202 patients treated with EVT from four comprehensive stroke centers. All patients were above 18 years of age and had symptoms onset of 6-24 h. mRS of 0-2 after three months was defined as favorable outcome.

Results: Patients with favorable outcome had lower median age (p = 0.003), lower pre-EVT National Institute of Health Stroke Scale (NIHSS) score (p = 0.000), lower diabetes mellitus (p = 0.041), stroke history (p = 0.041), parenchymal hematoma (PH) (p = 0.000) and fewer attempts to achieve successful recanalization (p = 0.001). Multivariate regression analysis found age (p = 0.007), diabetes mellitus (p = 0.022), successful recanalization (mTICI≥2b) (p = 0.006), NIHSS at onset (p = 0.000), and PH1 + PH2 Heidelberg bleeding classification (p = 0.009) as predictors of functional outcome.

Conclusion: Age, diabetes mellitus history, baseline NIHSS score, successful recanalization, and PH are predictors of 90-day functional outcome of late-window ischemic stroke patients undergoing EVT.

Keywords: endovascular therapy; ischemic stroke; large vessel occlusion; late time window used machine learning; patient outcome; thrombectomy.

Figure 1

A summary of patient selection criteria in the current study.