F Seker1, J Pfaff1, S Schönenberger2, C Herweh1, S Nagel2, P A Ringleb2, M Bendszus1, M A Möhlenbruch3. 1. From the Departments of Neuroradiology (F.S., J.P., C.H., M.B., M.A.M.). 2. Neurology (S.S., S.N., P.A.R.), Heidelberg University Hospital, Heidelberg, Germany. 3. From the Departments of Neuroradiology (F.S., J.P., C.H., M.B., M.A.M.) markus.moehlenbruch@med.uni-heidelberg.de.
Abstract
BACKGROUND AND PURPOSE: We aimed to analyze the clinical outcome after mechanical thrombectomy in patients with premorbid mRS 3 and 4 because there are currently no data on this patient group. MATERIALS AND METHODS: Between January 2009 and November 2017, all patients with premorbid mRS 3 or 4 undergoing mechanical thrombectomy due to anterior circulation stroke were selected. Good outcome was defined as a clinical recovery to the status before stroke onset (ie, equal premorbid mRS and mRS at 90 days). In addition, mortality at discharge and at 90 days was analyzed. RESULTS: One hundred thirty-six patients were included, of whom 81.6% presented with premorbid mRS 3; and 18.4%, with premorbid mRS 4; 24.0% of patients with premorbid mRS 4 achieved clinical recovery compared with 20.7% of patients with premorbid mRS 3 (P = .788). However, the proportion of hospital mortality and mortality at 90 days was nonsignificant, but markedly higher in patients with premorbid mRS 4. Multivariate analysis identified low NIHSS scores (OR, 0.92; 95% CI, 0.85-0.99; P = .040), high ASPECTS (OR, 1.45; 95% CI, 1.02-2.16; P = .049), and TICI 2b-3 (OR, 7.11; 95% CI, 1.73-49.90; P = .017) as independent predictors of good outcome. CONCLUSIONS: Good outcome in patients with premorbid mRS 3 and 4 is less frequent compared with premorbid mRS 0-2. Nevertheless, about 20% of the patients return to their premorbid mRS, which may justify endovascular treatment. The most important predictor of good outcome is successful recanalization.
BACKGROUND AND PURPOSE: We aimed to analyze the clinical outcome after mechanical thrombectomy in patients with premorbid mRS 3 and 4 because there are currently no data on this patient group. MATERIALS AND METHODS: Between January 2009 and November 2017, all patients with premorbid mRS 3 or 4 undergoing mechanical thrombectomy due to anterior circulation stroke were selected. Good outcome was defined as a clinical recovery to the status before stroke onset (ie, equal premorbid mRS and mRS at 90 days). In addition, mortality at discharge and at 90 days was analyzed. RESULTS: One hundred thirty-six patients were included, of whom 81.6% presented with premorbid mRS 3; and 18.4%, with premorbid mRS 4; 24.0% of patients with premorbid mRS 4 achieved clinical recovery compared with 20.7% of patients with premorbid mRS 3 (P = .788). However, the proportion of hospital mortality and mortality at 90 days was nonsignificant, but markedly higher in patients with premorbid mRS 4. Multivariate analysis identified low NIHSS scores (OR, 0.92; 95% CI, 0.85-0.99; P = .040), high ASPECTS (OR, 1.45; 95% CI, 1.02-2.16; P = .049), and TICI 2b-3 (OR, 7.11; 95% CI, 1.73-49.90; P = .017) as independent predictors of good outcome. CONCLUSIONS: Good outcome in patients with premorbid mRS 3 and 4 is less frequent compared with premorbid mRS 0-2. Nevertheless, about 20% of the patients return to their premorbid mRS, which may justify endovascular treatment. The most important predictor of good outcome is successful recanalization.
Authors: Sanjana Salwi; Shawna Cutting; Alan D Salgado; Kiersten Espaillat; Matthew R Fusco; Michael T Froehler; Rohan V Chitale; Howard Kirshner; Matthew Schrag; Adam Jasne; Tina Burton; Brian Mac Grory; Ali Saad; Mahesh V Jayaraman; Tracy E Madsen; Katarina Dakay; Ryan McTaggart; Shadi Yaghi; Pooja Khatri; Akshitkumar M Mistry; Eva A Mistry Journal: J Stroke Cerebrovasc Dis Date: 2020-06-05 Impact factor: 2.136
Authors: Marek Sykora; Patrik Michel; Davide Strambo; Stefan Krebs; Julia Ferrari; Alexandra Posekany; Dominika Mikšová; Konstantin Hermann; Thomas Gattringer; Elke Gizewski; Hannes Deutschmann; Christian Neumann; Wilfried Lang Journal: J Stroke Date: 2022-09-30 Impact factor: 8.632
Authors: Maximilian I Sprügel; Jochen A Sembill; Svenja Kremer; Stefan T Gerner; Michael Knott; Stefan Hock; Tobias Engelhorn; Arnd Dörfler; Hagen B Huttner; Stefan Schwab Journal: JAMA Netw Open Date: 2022-08-01