Italo Linfante1, Amy K Starosciak2, Gail R Walker3, Guilherme Dabus1, Alicia C Castonguay4, Rishi Gupta5, Chung-Huan J Sun5, Coleman Martin6, William E Holloway6, Nils Mueller-Kronast7, Joey D English8, Tim W Malisch9, Franklin A Marden9, Hormozd Bozorgchami10, Andrew Xavier11, Ansaar T Rai12, Michael T Froehler13, Aamir Badruddin14, Thanh N Nguyen15, M Asif Taqi6, Michael G Abraham16, Vallabh Janardhan17, Hashem Shaltoni18, Roberta Novakovic19, Albert J Yoo20, Alex Abou-Chebl21, Peng R Chen22, Gavin W Britz23, Ritesh Kaushal24, Ashish Nanda25, Mohammad A Issa4, Raul G Nogueira5, Osama O Zaidat4. 1. Miami Cardiac and Vascular Institute, Baptist Hospital, Miami, Florida, USA Neuroscience Center, Baptist Hospital, Miami, Florida, USA. 2. Neuroscience Center, Baptist Hospital, Miami, Florida, USA Center for Research and Grants, Baptist Health South Florida, Coral Gables, Florida, USA. 3. Center for Research and Grants, Baptist Health South Florida, Coral Gables, Florida, USA. 4. Medical College of Wisconsin/Froedtert Hospital, Milwaukee, Wisconsin, USA. 5. Emory University School of Medicine, Atlanta, Georgia, USA. 6. St. Luke's Kansas City, Kansas City, Missouri, USA. 7. Delray Medical Center, Delray Beach, Florida, USA. 8. California Pacific Medical Center, San Francisco, California, USA. 9. Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA. 10. Oregon Health and Sciences, Portland, Oregon, USA. 11. Wayne State University School of Medicine, Detroit, Michigan, USA. 12. West Virginia University Hospital, Morgantown, West Virginia, USA. 13. Vanderbilt University Medical Center, Nashville, Tennessee, USA. 14. Provena St. Joseph Medical Center, Joliet, Illinois, USA. 15. Boston Medical Center, Boston, Massachusetts, USA. 16. University of Kansas Medical Center, Kansas City, Kansas, USA. 17. Texas Stroke Institute, Plano, Texas, USA. 18. Baylor College of Medicine, Houston, Texas, USA. 19. UT Southwestern Medical Center, Dallas, Texas, USA. 20. Massachusetts General Hospital, Boston, Massachusetts, USA. 21. Baptist Health Louisville, Louisville, Kentucky, USA. 22. The University of Texas Medical School at Houston, Houston, Texas, USA. 23. Methodist Neurological Institute, Houston, Texas, USA. 24. St Louis University, St Louis, Missouri, USA. 25. University of Missouri, Columbia, Missouri, USA.
Abstract
BACKGROUND: Mechanical thrombectomy with stent-retrievers results in higher recanalization rates compared with previous devices. Despite successful recanalization rates (Thrombolysis in Cerebral Infarction (TICI) score ≥2b) of 70-83%, good outcomes by 90-day modified Rankin Scale (mRS) score ≤2 are achieved in only 40-55% of patients. We evaluated predictors of poor outcomes (mRS >2) despite successful recanalization (TICI ≥2b) in the North American Solitaire Stent Retriever Acute Stroke (NASA) registry. METHODS: Logistic regression was used to evaluate baseline characteristics and recanalization outcomes for association with 90-day mRS score of 0-2 (good outcome) vs 3-6 (poor outcome). Univariate tests were carried out for all factors. A multivariable model was developed based on backwards selection from the factors with at least marginal significance (p≤0.10) on univariate analysis with the retention criterion set at p≤0.05. The model was refit to minimize the number of cases excluded because of missing covariate values; the c-statistic was a measure of predictive power. RESULTS: Of 354 patients, 256 (72.3%) were recanalized successfully. Based on 234 recanalized patients evaluated for 90-day mRS score, 116 (49.6%) had poor outcomes. Univariate analysis identified an increased risk of poor outcome for age ≥80 years, occlusion site of internal carotid artery (ICA)/basilar artery, National Institute of Health Stroke Scale (NIHSS) score ≥18, history of diabetes mellitus, TICI 2b, use of rescue therapy, not using a balloon-guided catheter or intravenous tissue plasminogen activator (IV t-PA), and >30 min to recanalization (p≤0.05). In multivariable analysis, age ≥80 years, occlusion site ICA/basilar, initial NIHSS score ≥18, diabetes, absence of IV t-PA, ≥3 passes, and use of rescue therapy were significant independent predictors of poor 90-day outcome in a model with good predictive power (c-index=0.80). CONCLUSIONS: Age, occlusion site, high NIHSS, diabetes, no IV t-PA, ≥3 passes, and use of rescue therapy are associated with poor 90-day outcome despite successful recanalization. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
BACKGROUND: Mechanical thrombectomy with stent-retrievers results in higher recanalization rates compared with previous devices. Despite successful recanalization rates (Thrombolysis in Cerebral Infarction (TICI) score ≥2b) of 70-83%, good outcomes by 90-day modified Rankin Scale (mRS) score ≤2 are achieved in only 40-55% of patients. We evaluated predictors of poor outcomes (mRS >2) despite successful recanalization (TICI ≥2b) in the North American Solitaire Stent Retriever Acute Stroke (NASA) registry. METHODS: Logistic regression was used to evaluate baseline characteristics and recanalization outcomes for association with 90-day mRS score of 0-2 (good outcome) vs 3-6 (poor outcome). Univariate tests were carried out for all factors. A multivariable model was developed based on backwards selection from the factors with at least marginal significance (p≤0.10) on univariate analysis with the retention criterion set at p≤0.05. The model was refit to minimize the number of cases excluded because of missing covariate values; the c-statistic was a measure of predictive power. RESULTS: Of 354 patients, 256 (72.3%) were recanalized successfully. Based on 234 recanalized patients evaluated for 90-day mRS score, 116 (49.6%) had poor outcomes. Univariate analysis identified an increased risk of poor outcome for age ≥80 years, occlusion site of internal carotid artery (ICA)/basilar artery, National Institute of Health Stroke Scale (NIHSS) score ≥18, history of diabetes mellitus, TICI 2b, use of rescue therapy, not using a balloon-guided catheter or intravenous tissue plasminogen activator (IV t-PA), and >30 min to recanalization (p≤0.05). In multivariable analysis, age ≥80 years, occlusion site ICA/basilar, initial NIHSS score ≥18, diabetes, absence of IV t-PA, ≥3 passes, and use of rescue therapy were significant independent predictors of poor 90-day outcome in a model with good predictive power (c-index=0.80). CONCLUSIONS: Age, occlusion site, high NIHSS, diabetes, no IV t-PA, ≥3 passes, and use of rescue therapy are associated with poor 90-day outcome despite successful recanalization. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
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Authors: Tim W Malisch; Osama O Zaidat; Alicia C Castonguay; Franklin A Marden; Rishi Gupta; Chung-Huan J Sun; Coleman O Martin; William E Holloway; Nils Mueller-Kronast; Joey English; Italo Linfante; Guilherme Dabus; Hormozd Bozorgchami; Andrew Xavier; Ansaar T Rai; Michael Froehler; Aamir Badruddin; Thanh N Nguyen; M Asif Taqi; Michael G Abraham; Vallabh Janardhan; Hashem Shaltoni; Robin Novakovic; Albert J Yoo; Alex Abou-Chebl; Peng Roc Chen; Gavin W Britz; Ritesh Kaushal; Ashish Nanda; Raul G Nogueira Journal: Interv Neurol Date: 2017-10-11