Journal Article

Predictors of poor outcome despite successful endovascular treatment for ischemic stroke: results from the MR CLEAN Registry

van de Graaf, Rob A, Jong, Anouk de, Dijk, Lukas C van, Oostenbrugge, Robert J van, Ghannouti, Naziha el, Bot, Joost, Menno Krietemeijer, G, Droste, Hanneke, Meijer, Anton, Vemde, Gina van, Bodde, Karin, Konduri, Praneeta R, Roozenbeek, Bob, van der Lugt, Aad, Jeurrissen, D, van Beusekom, Heleen, Coutinho, Jonathan M, Boogaarts, Hieronymus D, Bokkers, Reinoud PH, Mens, Marieke A, Dippel, Diederik W J, Dijk, Ewoud J van, Yo, Lonneke SF, Emmer, Bart J, Ponjee, Eva, de Vries, J, Vermeulen, Tamara, Collette, Sabine, Sprengers, Rita, Hoorn, Anouk van der, Romviel, Sharon, Schupp, Lieve M, Lo, Rob H, Messchendorp, Gert, Muijres, Daan, Staals, Julie, Boiten, Jelis, Beenen, Ludo FM, Appelman, Auke PA, Groot, Adrien ED, Mulder, Maxim JHL, Martens, Jasper M, Simons, Michelle, Geuskens, Ralph R, Schonewille, Wouter J, Pellikaan, Wilma, Nicolaij, Nynke, Kanselaar, Karin, van Es, Adriaan C G M, Vinke, Saman, Lingsma, Hester F, Bongenaar, Hester, Boers, Anna MM, van Zwam, Wim H, Heijboer, Roel JJ, Berg, Jan SP van den, Aerden, Leo AM, Tuijl, Julia van, Roosendaal, Stefan D, Voogd, Eva JHF, Peluso, Jo P, Harmsma, Roger

2022

Overview

BackgroundApproximately one-third of patients with ischemic stroke treated with endovascular treatment do not recover to functional independence despite rapid and successful recanalization. We aimed to quantify the importance of predictors of poor functional outcome despite successful reperfusion.MethodsWe analyzed patients from the MR CLEAN Registry between March 2014 and November 2017 with successful reperfusion (extended Thrombolysis In Cerebral Infarction ≥2B). First, predictors were selected based on expert opinion and were clustered according to acquisition over time (ie, baseline patient factors, imaging factors, treatment factors, and postprocedural factors). Second, several models were constructed to predict 90-day functional outcome (modified Rankin Scale (mRS)). The relative importance of individual predictors in the most extensive model was expressed by the proportion of unique added χ2 to the model of that individual predictor.ResultsOf 3180 patients, 1913 (60%) had successful reperfusion. Of these 1913 patients, 1046 (55%) were functionally dependent at 90 days (mRS >2). The most important predictors for mRS were baseline patient factors (ie, pre-stroke mRS, added χ2 0.16; National Institutes of Health Stroke Scale score at baseline, added χ2 0.12; age, added χ2 0.10), and postprocedural factors (ie, symptomatic intracranial hemorrhage (sICH), added χ2 0.12; pneumonia, added χ2 0.09). The probability of functional independence for a typical stroke patient with sICH was 54% (95% CI 36% to 72%) lower compared with no sICH, and 21% (95% CI 4% to 38%) for pneumonia compared with no pneumonia.ConclusionBaseline patient factors and postprocedural adverse events are important predictors of poor functional outcome in successfully reperfused patients with ischemic stroke. This implies that prevention of postprocedural adverse events has the greatest potential to further improve outcomes in these patients.

• Publisher: BMJ Publishing Group Ltd,BMJ Publishing Group LTD
• Subject: Blood pressure / Brain Ischemia - diagnostic imaging / Brain Ischemia - surgery / Carotid arteries / Endovascular Procedures - adverse effects / Endovascular Procedures - methods / Humans / intervention / Intracranial Hemorrhages - etiology / Ischemic Stroke / Patients / Pneumonia / Registries / Stroke / Stroke - diagnostic imaging / Stroke - surgery / thrombectomy / Thrombectomy - adverse effects / Thrombectomy - methods / Thrombolytic drugs / Treatment Outcome / Veins & arteries