Italo Linfante1, Gail R Walker2, Alicia C Castonguay2, Guilherme Dabus2, Amy K Starosciak2, Albert J Yoo2, Alex Abou-Chebl2, Gavin W Britz2, Franklin A Marden2, Alexandria Alvarez2, Rishi Gupta2, Chun-Huan J Sun2, Coleman Martin2, William E Holloway2, Nils Mueller-Kronast2, Joey D English2, Tim W Malisch2, Hormozd Bozorgchami2, Andrew Xavier2, Ansaar T Rai2, Michael T Froehler2, Aamir Badruddin2, Thanh N Nguyen2, M Asif Taqi2, Michael G Abraham2, Vallabh Janardhan2, Hashem Shaltoni2, Roberta Novakovic2, Peng R Chen2, Ritesh Kaushal2, Ashish Nanda2, Mohammad A Issa2, Raul G Nogueira2, Osama O Zaidat2. 1. From the Miami Cardiac and Vascular Institute (I.L., G.D., A.A.) and Neuroscience Center, Baptist Hospital (I.L., G.R.W., G.D., A.K.S., A.A., J.D.E.), Miami, FL; Massachusetts General Hospital, Boston (A.J.Y.); Methodist Neurological Institute, Houston, TX (G.W.B.); Baptist Health Louisville, KY (A.A.-C.); Alexian Brothers Medical Center, Elk Grove Village, IL (F.A.M.. T.W.M.); Medical College of Wisconsin/Froedtert Hospital, Milwaukee (A.C.C., M.A.I.. O.O.Z.); Emory University School of Medicine, Atlanta, GA (R.G., C.-H.J.S., R.G.N.); St. Luke's Kansas City, MO (C.M., W.E.H.); Delray Medical Center, Delray Beach, FL (N.M.-K.); California Pacific Medical Center, San Francisco, CA (J.D.E.); Oregon Health and Sciences, Portland (H.B.); Wayne State University School of Medicine, Detroit, MI (A.X.); West Virginia University Hospital, Morgantown, (A.T.R.); Vanderbilt University Medical Center, Nashville, TN (M.T.F.); Provena St. Joseph Medical Center, Joliet, IL (A.B.); Boston Medical Center, MA (T.N.N.); Desert Regional Medical Center, Palm Springs, CA (M.A.T.); University of Kansas Medical Center, KS (M.G.A.); Texas Stroke Institute, Plano (V.J.); Baylor College of Medicine, Houston, TX (H.S.); UT Southwestern Medical Center, Dallas, TX (R.N.); The University of Texas Medical School at Houston (P.R.C.); St. Louis University, MO (R.K.); and University of Missouri, Columbia (A.N.). italol@baptisthealth.net. 2. From the Miami Cardiac and Vascular Institute (I.L., G.D., A.A.) and Neuroscience Center, Baptist Hospital (I.L., G.R.W., G.D., A.K.S., A.A., J.D.E.), Miami, FL; Massachusetts General Hospital, Boston (A.J.Y.); Methodist Neurological Institute, Houston, TX (G.W.B.); Baptist Health Louisville, KY (A.A.-C.); Alexian Brothers Medical Center, Elk Grove Village, IL (F.A.M.. T.W.M.); Medical College of Wisconsin/Froedtert Hospital, Milwaukee (A.C.C., M.A.I.. O.O.Z.); Emory University School of Medicine, Atlanta, GA (R.G., C.-H.J.S., R.G.N.); St. Luke's Kansas City, MO (C.M., W.E.H.); Delray Medical Center, Delray Beach, FL (N.M.-K.); California Pacific Medical Center, San Francisco, CA (J.D.E.); Oregon Health and Sciences, Portland (H.B.); Wayne State University School of Medicine, Detroit, MI (A.X.); West Virginia University Hospital, Morgantown, (A.T.R.); Vanderbilt University Medical Center, Nashville, TN (M.T.F.); Provena St. Joseph Medical Center, Joliet, IL (A.B.); Boston Medical Center, MA (T.N.N.); Desert Regional Medical Center, Palm Springs, CA (M.A.T.); University of Kansas Medical Center, KS (M.G.A.); Texas Stroke Institute, Plano (V.J.); Baylor College of Medicine, Houston, TX (H.S.); UT Southwestern Medical Center, Dallas, TX (R.N.); The University of Texas Medical School at Houston (P.R.C.); St. Louis University, MO (R.K.); and University of Missouri, Columbia (A.N.).
Abstract
BACKGROUND AND PURPOSE: Failure to recanalize predicts mortality in acute ischemic stroke. In the North American Solitaire Acute Stroke registry, we investigated parameters associated with mortality in successfully recanalized patients. METHODS: Logistic regression was used to evaluate baseline characteristics and recanalization parameters for association with 90-day mortality. A multivariable model was developed based on backward selection with retention criteria of P<0.05 from factors with at least marginal significance (P≤0.10), then refit to minimize the number of excluded cases (missing data). RESULTS: Successfully recanalized patients had lower mortality (25.2% [59/234] versus 46.9% [38/81] P<0.001). There was no difference in symptomatic intracranial hemorrhage between patients with successful versus failed recanalization (9% [21/234] versus 14% [11/79]; P=0.205). However, mortality was significantly higher in patients with symptomatic intracranial hemorrhage (72% [23/32] versus 26% [73/281]; P<0.001). Proximal occlusion (internal carotid artery or vertebrobasilar), initial National Institutes of Health Stroke Scale≥18, use of rescue therapy (P<0.05), and 3+ passes (P<0.10) were associated with mortality in recanalized patients. In the multivariate model with good predictive power (c index=0.72), proximal occlusion, initial National Institutes of Health Stroke Scale≥18, and use of rescue therapy remained significant independent predictors of 90-day mortality. CONCLUSIONS: Failure to recanalize and presence of symptomatic intracranial hemorrhage resulted in increased mortality. Despite successful recanalization, proximal occlusion, high National Institutes of Health Stroke Scale, and need for rescue therapy were predictors of mortality.
BACKGROUND AND PURPOSE: Failure to recanalize predicts mortality in acute ischemic stroke. In the North American Solitaire Acute Stroke registry, we investigated parameters associated with mortality in successfully recanalized patients. METHODS: Logistic regression was used to evaluate baseline characteristics and recanalization parameters for association with 90-day mortality. A multivariable model was developed based on backward selection with retention criteria of P<0.05 from factors with at least marginal significance (P≤0.10), then refit to minimize the number of excluded cases (missing data). RESULTS: Successfully recanalized patients had lower mortality (25.2% [59/234] versus 46.9% [38/81] P<0.001). There was no difference in symptomatic intracranial hemorrhage between patients with successful versus failed recanalization (9% [21/234] versus 14% [11/79]; P=0.205). However, mortality was significantly higher in patients with symptomatic intracranial hemorrhage (72% [23/32] versus 26% [73/281]; P<0.001). Proximal occlusion (internal carotid artery or vertebrobasilar), initial National Institutes of Health Stroke Scale≥18, use of rescue therapy (P<0.05), and 3+ passes (P<0.10) were associated with mortality in recanalized patients. In the multivariate model with good predictive power (c index=0.72), proximal occlusion, initial National Institutes of Health Stroke Scale≥18, and use of rescue therapy remained significant independent predictors of 90-day mortality. CONCLUSIONS: Failure to recanalize and presence of symptomatic intracranial hemorrhage resulted in increased mortality. Despite successful recanalization, proximal occlusion, high National Institutes of Health Stroke Scale, and need for rescue therapy were predictors of mortality.
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
Authors: Fode A Cisse; Charlotte Damien; Aissatou K Bah; M L Touré; M Barry; A B Djibo Hamani; Michel Haba; Fode M Soumah; Gilles Naeije Journal: Front Neurol Date: 2019-08-07 Impact factor: 4.003
Authors: Aristeidis H Katsanos; Konark Malhotra; Nitin Goyal; Lina Palaiodimou; Peter D Schellinger; Valeria Caso; Charlotte Cordonnier; Guillaume Turc; Georgios Magoufis; Adam Arthur; Andrei V Alexandrov; Georgios Tsivgoulis Journal: J Am Heart Assoc Date: 2019-10-28 Impact factor: 5.501