Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Oct 1;7(1):71.
doi: 10.1186/s42466-025-00427-7.

Mortality within three months after nonfatal ischemic stroke treated by mechanical thrombectomy in routine care-data from the German Stroke Registry

Marianne Hahn  1 , Sonja Gröschel  1 , Livia Sophie Lang  1 , Ahmed E Othman  2 , Klaus Gröschel #  3 , Timo Uphaus #  1 ; German Stroke Registry – Endovascular Treatment (GSR-ET) investigators
Collaborators, Affiliations

Mortality within three months after nonfatal ischemic stroke treated by mechanical thrombectomy in routine care-data from the German Stroke Registry

Marianne Hahn et al. Neurol Res Pract. .

Abstract

Background: Mechanical thrombectomy (MT) is a highly effective treatment for large vessel occlusion (LVO) ischemic stroke. However, a substantial share of patients have lethal outcome within 3 months. Individualization of outcome prognostication is needed to support clinical decision-making throughout the care pathway after MT. We investigate predictors of lethal outcome in patients with nonfatal LVO, defined by discharge alive from primary treating hospital, in a large prospective registry study of MT under routine care conditions.

Methods: 6,518 patients with nonfatal LVO treated by MT enrolled in the German Stroke Registry-Endovascular Treatment from May 2015-December 2021 were analysed with regard to lethal outcome by 3 month follow-up. Univariate group comparisons and multiple logistic regression analysis were performed to identify patients with high odds for survival or lethal outcome.

Results: We report 11.6% (757/6,518) 3 month mortality following hospital discharge after LVO treated by MT. Besides better functional outcome at discharge (modified Rankin scale < 4, odds ratio, OR [95% confidence interval, CI]: 2.38 [1.71-3.32], p < 0.001; National Institute of Health Stroke scale < 8, OR [95%CI]: 3.45 [2.55-4.66], p < 0.001), intravenous thrombolysis (OR [95%CI]: 1.48 [1.17-1.88], p = 0.001), successful recanalization (OR [95%CI]: 1.43 [1.08-1.90], p = 0.014) and discharge to a neurorehabilitative facility (versus nursing home: OR [95%CI]: 0.39 [0.26-0.58], p < 0.001; versus home: OR [95%CI]: 0.69 [0.49-0.97], p = 0.032) were independent predictors of survival. Predictors of lethal outcome were older age (OR [95%CI]: 1.09 [1.07-1.10], p < 0.001), male sex (OR [95%CI]: 1.24 [1.00-1.55], p = 0.049), premorbid disability (OR [95%CI]: 1.47 [1.08-2.02], p = 0.016), active smoking (OR [95%CI]: 1.51 [1.06-2.14], p = 0.023), anticoagulation therapy prior to LVO (OR [95%CI]: 1.45 [1.09-1.92], p = 0.010), stroke etiology, general anaesthesia during MT (OR [95%CI]: 1.31 [1.02-1.69], p = 0.035) and intracerebral haemorrhage (OR [95%CI]: 1.50 [1.13-1.99], p = 0.005).

Conclusions: Lethal outcome after hospital discharge within 3 months after MT is frequent, accounting for more than one quarter of overall 3-month mortality after MT of LVO. Predictors of survival enable individual outcome prognostication, which assists clinical decision-making with regard to surveillance concerning complications, rehabilitative resource allocation and counselling about goals of care.

Trial registration: ClinicalTrials.gov (Identifier: NCT03356392, Date of registration: 2017/11/22).

Keywords: Complications; Endovascular stroke therapy; Ischemic stroke; Mechanical thrombectomy; Mortality; Registry studies.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: Study protocols and procedures were conducted in compliance with the Declaration of Helsinki. The German Stroke Registry–Endovascular Treatment (GSR-ET) is registered at ClinicalTrials.gov (Identifier: NCT03356392, date of registration: 2017/11/22) and was approved by the ethics committee of the leading center (Ludwig-Maximilians University Munich, protocol number: 689–15) and by the local ethics committees. Written informed consent was obtained from all participants (or guardians of participants). Consent for publication: Not applicable. Competing interests: AEO: speakers bureau and research grants from Canon medical. KG: personal fees and/or non-financial support from Abbott Medical, Boehringer Ingelheim, Bristol-Meyers Squibb and Pfizer Pharma GmbH. TU: personal fees from Merck Serono and Pfizer, grants from Else Kröner-Fresenius Stiftung. All other authors report no disclosures relevant to the manuscript.

Figures

Fig. 1
Fig. 1
Premorbid functional status and outcome at discharge and 90 day follow-up after mechanical thrombectomy. Abbreviations: mRS: modified Rankin Scale
Fig. 2
Fig. 2
90-day mortality in nonfatal stroke treated by mechanical thrombectomy depending on age, stroke severity and functional outcome at discharge. Abbreviations: NIHSS: National Institutes of Health Stroke Scale, mRS: modified Rankin Scale
Fig. 3
Fig. 3
Independent predictors of 90-day mortality in nonfatal stroke treated by mechanical thrombectomy resulting from multiple logistic regression modelling (Nagelkerkes R2 = 0.336, p < 0.001). Abbreviations: mRS: modified Rankin Scale, LAA: large artery atherosclerosis, MT: mechanical thrombectomy, TICI: Thrombolysis in cerebral infarction scale, NIHSS: National Institutes of Health Stroke Scale
See this image and copyright information in PMC

References

    1. Alegiani, A. C., Dorn, F., Herzberg, M., Wollenweber, F. A., Kellert, L., Siebert, E., Nolte, C. H., Rennenberg, R., Hattingen, E., Petzold, G. C., Bode, F. J., Pfeilschifter, W., Schäfer, J. H., Wagner, M., Röther, J., Eckert, B., Kraft, P., Pham, M., Boeckh-Behrens, T., & Thomalla, G. (2019). Systematic evaluation of stroke thrombectomy in clinical practice: The German stroke registry endovascular treatment. International Journal of Stroke,14(4), 372–380. 10.1177/1747493018806199 - PubMed
    1. Burton, C. R., Payne, S., Addington-Hall, J., & Jones, A. (2010). The palliative care needs of acute stroke patients: A prospective study of hospital admissions. Age and Ageing,39(5), 554–559. 10.1093/ageing/afq077 - PubMed
    1. Bustamante, A., Giralt, D., García-Berrocoso, T., Rubiera, M., Álvarez-Sabín, J., Molina, C., Serena, J., & Montaner, J. (2017). The impact of post-stroke complications on in-hospital mortality depends on stroke severity. European Stroke Journal,2(1), 54–63. 10.1177/2396987316681872 - PMC - PubMed
    1. Campbell, D., Butler, E., Campbell, R. B., Ho, J., & Barber, P. A. (2023). General anesthesia compared with non-GA in endovascular thrombectomy for ischemic stroke: A systematic review and meta-analysis of randomized controlled trials. Neurology,100(16), e1655–e1663. 10.1212/WNL.0000000000207066 - PMC - PubMed
    1. Chabanne, R., Geeraerts, T., Begard, M., Balança, B., Rapido, F., Degos, V., Tavernier, B., Molliex, S., Velly, L., Verdonk, F., Lukaszewicz, A.-C., Perrigault, P.-F., Albucher, J.-F., Cognard, C., Guyot, A., Fernandez, C., Masgrau, A., Moreno, R., Ferrier, A., & Futier, E. (2023). Outcomes after endovascular therapy with procedural sedation vs general anesthesia in patients with acute ischemic stroke: The AMETIS randomized clinical trial. JAMA Neurology,80(5), 474–483. 10.1001/jamaneurol.2023.0413 - PMC - PubMed

Associated data

LinkOut - more resources