OBJECTIVE: Mechanical thrombectomy is the established treatment for acute ischemic stroke due to large vessel occlusion (LVO). The authors sought to identify early predictors of a favorable outcome in stroke patients treated with mechanical thrombectomy. METHODS: Consecutive patients with ischemic stroke due to LVO who underwent mechanical thrombectomy at a Comprehensive Stroke Center in the US between 2016 and 2018 were retrospectively reviewed. Demographics, stroke and treatment characteristics, as well as functional outcome at 90 days were collected. Clinical predictors of 90-day functional outcome were assessed and compared to existing indices for prompt neurological improvement. Analyses of area under the receiver operating characteristic curve were performed to estimate the optimal thresholds for absolute 24-hour and delta (change in) National Institutes of Health Stroke Scale (NIHSS) scores for functional outcome prediction. RESULTS: A total of 156 patients (median age 71.5 years) underwent 159 mechanical thrombectomies. The M1 segment of the middle cerebral artery was the most frequent site of occlusion (57.2%). The median NIHSS score before thrombectomy was 18 (IQR 14-24). A postthrombectomy Thrombolysis in Cerebral Infarction score of 2B or 3 was achieved in 147 procedures (92.4%). The median NIHSS score 24 hours after thrombectomy was 14 (IQR 6-22). Good functional outcome at 90 days (modified Rankin Scale score 0-2) was achieved in 37 thrombectomies (23.9%). An absolute 24-hour NIHSS score ≤ 10 (OR 25.929, 95% CI 8.448-79.582, p < 0.001) and a delta NIHSS score ≥ 8 between baseline and 24 hours (OR 4.929, 95% CI 2.245-10.818, p < 0.001) were associated with good functional outcome at 90 days. The 24-hour NIHSS score cutoff of 10 outperformed existing indices for prompt neurological improvement in the ability to predict 90-day functional outcome. CONCLUSIONS: An NIHSS score ≤ 10 at 24 hours after mechanical thrombectomy was independently associated with good functional outcome at 90 days.
OBJECTIVE: Mechanical thrombectomy is the established treatment for acute ischemic stroke due to large vessel occlusion (LVO). The authors sought to identify early predictors of a favorable outcome in strokepatients treated with mechanical thrombectomy. METHODS: Consecutive patients with ischemic stroke due to LVO who underwent mechanical thrombectomy at a Comprehensive Stroke Center in the US between 2016 and 2018 were retrospectively reviewed. Demographics, stroke and treatment characteristics, as well as functional outcome at 90 days were collected. Clinical predictors of 90-day functional outcome were assessed and compared to existing indices for prompt neurological improvement. Analyses of area under the receiver operating characteristic curve were performed to estimate the optimal thresholds for absolute 24-hour and delta (change in) National Institutes of Health Stroke Scale (NIHSS) scores for functional outcome prediction. RESULTS: A total of 156 patients (median age 71.5 years) underwent 159 mechanical thrombectomies. The M1 segment of the middle cerebral artery was the most frequent site of occlusion (57.2%). The median NIHSS score before thrombectomy was 18 (IQR 14-24). A postthrombectomy Thrombolysis in Cerebral Infarction score of 2B or 3 was achieved in 147 procedures (92.4%). The median NIHSS score 24 hours after thrombectomy was 14 (IQR 6-22). Good functional outcome at 90 days (modified Rankin Scale score 0-2) was achieved in 37 thrombectomies (23.9%). An absolute 24-hour NIHSS score ≤ 10 (OR 25.929, 95% CI 8.448-79.582, p < 0.001) and a delta NIHSS score ≥ 8 between baseline and 24 hours (OR 4.929, 95% CI 2.245-10.818, p < 0.001) were associated with good functional outcome at 90 days. The 24-hour NIHSS score cutoff of 10 outperformed existing indices for prompt neurological improvement in the ability to predict 90-day functional outcome. CONCLUSIONS: An NIHSS score ≤ 10 at 24 hours after mechanical thrombectomy was independently associated with good functional outcome at 90 days.
Entities:
Keywords:
ASPECTS = Alberta Stroke Program Early CT Score; AUC = area under the receiver operating characteristic curve; CSC = Comprehensive Stroke Center; DEFUSE 3 = Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3; DNI = dramatic neurological improvement; ENI = early neurological improvement; IQR = interquartile range; LVO = large vessel occlusion; NIHSS = National Institutes of Health Stroke Scale; RNI = rapid neurological improvement; TICI = Thrombolysis in Cerebral Infarction; endovascular; interventional; ischemic; large vessel occlusion; mRS = modified Rankin Scale; outcome; stroke scale; tPA = tissue plasminogen activator; thrombectomy; vascular disorders
Authors: M Laflamme; S Carrondo-Cottin; M-M Valdès; D Simonyan; M-È Audet; J-L Gariépy; M-C Camden; C Gariépy; S Verreault; P Lavoie Journal: AJNR Am J Neuroradiol Date: 2022-09-22 Impact factor: 4.966
Authors: Yan Li; Natalie van Landeghem; Aydin Demircioglu; Martin Köhrmann; Elias Kellner; Lennart Milles; Benjamin Stolte; Andreas Totzeck; Philipp Dammann; Karsten Wrede; Jens Matthias Theysohn; Hanna Styczen; Michael Forsting; Isabel Wanke; Benedikt Frank; Cornelius Deuschl Journal: Clin Neuroradiol Date: 2022-03-04 Impact factor: 3.156