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What predicts poor outcome after successful thrombectomy in early time window?

What predicts poor outcome after successful thrombectomy in early time window? Journal of neurointerventional surgery Olivot, J., Heit, J. J., Mazighi, M., Raposo, N., Albucher, J. F., Rousseau, V., Guenego, A., Thalamas, C., Mlynash, M., Drif, A., Christensen, S., Sommet, A., Viguier, A., Darcourt, J., Januel, A., Calviere, L., Menegon, P., Caparros, F., Bonneville, F., Tourdias, T., Sibon, I., Albers, G. W., Cognard, C., FRAME Investigators, Fontaine, L., Chollet, F., Barbieux, M., Michelozzi, C., Tall, P., Pouzet, B., Calvas, F., Galitzki, M., Renou, P., Rouanet, F., Berge, J., Marnat, G., Lucas, L., Coignon, C., Sagnier, S., Debruxelle, S., Ledure, S. 2021

Abstract

BACKGROUND: Half of the patients with large vessel occlusion (LVO)-related acute ischemic stroke (AIS) who undergo endovascular reperfusion are dead or dependent at 3 months. We hypothesize that in addition to established prognostic factors, baseline imaging profile predicts outcome among reperfusers.METHODS: Consecutive patients receiving endovascular treatment (EVT) within 6hours after onset with Thrombolysis In Cerebral Infarction (TICI) 2b, 2c and 3 revascularization were included. Poor outcome was defined by a modified Rankin scale (mRS) 3-6 at 90 days. No mismatch (NoMM) profile was defined as a mismatch (MM) ratio =1.2 and/or a volume <10mL on pretreatment imaging.RESULTS: 187 patients were included, and 81 (43%) had a poor outcome. Median delay from stroke onset to the end of EVT was 259min (IQR 209-340). After multivariable logistic regression analysis, older age (OR 1.26, 95% CI 1.06 to 1.5; p=0.01), higher National Institutes of Health Stroke Scale (NIHSS) (OR 1.15, 95% CI 1.06 to 1.25; p<0.0001), internal carotid artery (ICA) occlusion (OR 3.02, 95% CI 1.2 to 8.0; p=0.021), and NoMM (OR 4.87, 95% CI 1.09 to 22.8; p=0.004) were associated with poor outcome. In addition, post-EVT hemorrhage (OR 3.64, 95% CI 1.5 to 9.1; p=0.04) was also associated with poor outcome.CONCLUSIONS: The absence of a penumbra defined by a NoMM profile on baseline imaging appears to be an independent predictor of poor outcome after reperfusion. Strategies aiming to preserve the penumbra may be encouraged to improve these patients' outcomes.

View details for DOI 10.1136/neurintsurg-2021-017946

View details for PubMedID 34750109