Incidence and predictors of poor functional outcome despite complete recanalisation following endovascular thrombectomy for acute ischaemic stroke

被引：14

作者：

Dhillon, Permesh Singh ^{[1
,2
,6
]}

Butt, Waleed ^{[3
]}

Marei, Omar ^{[1
,6
]}

Podlasek, Anna ^{[4
]}

McConachie, Norman ^{[1
]}

Lenthall, Robert ^{[1
]}

Nair, Sujit ^{[1
]}

Malik, Luqman ^{[1
]}

Bhogal, Pervinder ^{[5
]}

Makalanda, Hegoda Levansri Dilrukshan ^{[5
]}

Dineen, Robert A. ^{[2
,6
]}

England, Timothy J. ^{[7
,8
,9
]}

机构：

[1] Nottingham Univ Hosp NHS Trust, Intervent Neuroradiol, Nottingham, England

[2] NIHR Nottingham Biomed Res Ctr, Nottingham, Nottinghamshire, England

[3] Univ Hosp Birmingham NHS Trust, Intervent Neuroradiol, Birmingham, England

[4] Univ Dundee, Tayside Innovat Medtech Ecosyst TIME, Dundee, Scotland

[5] Barts Hlth NHS Trust, Intervent Neuroradiol, London, England

[6] Univ Nottingham, Sch Med, Radiol Sci, Mental Hlth & Clin Neurosci, Nottingham, England

[7] Univ Nottingham, Sch Med, Stroke Trials Unit, Mental Hlth & Clin Neurosci, Nottingham, England

[8] Univ Hosp Derby, Derby, England

[9] Burton NHS Fdn Trust, Derby, England

来源：

JOURNAL OF STROKE & CEREBROVASCULAR DISEASES | 2023年 / 32卷 / 05期

关键词：

Endovascular thrombectomy; Symptomatic intracranial hemorrhage; Early neurological deterioration; Computed tomography; Stroke;

D O I：

10.1016/j.jstrokecerebrovasdis.2023.107083

中图分类号：

Q189 [神经科学];

学科分类号：

071006 ;

摘要：

Background: Numerous ischaemic stroke patients experience poor functional out-come despite successful recanalisation following endovascular thrombectomy (EVT). We aimed to identify the incidence and predictors of futile complete recanal-isation (FCR) in a national stroke registry. Methods: Patients who achieved complete recanalisation (mTICI 3) following EVT, between October 2015 and March 2020, were included from a United Kingdom national stroke registry. Modified Rankin Scale of 4-6 at discharge was defined as a 'poor/futile outcome'. Backward stepwise multivariable logistic regression analysis was performed with FCR as the depen-dent variable, incorporating all baseline characteristics, procedural time metrics and post-procedural events. Results: We included 2132 of 4383 patients (48.8%) with complete recanalisation post-EVT, of which 948 patients (44.4%) developed FCR. Following multivariable regression analysis adjusted for potential confound-ers, patients with FCR were associated with multiple baseline patient, imaging and procedural factors: age (p=0.0001), admission NIHSS scores (p=0.0001), pre-stroke disability (p=0.007), onset-to-puncture (p=0.0001) and procedural times (p=0.0001), presence of diabetes (p=0.005), and use of general anaesthesia (p=0.0001). Although not predictive of outcome, post-procedural events including development of any intracranial haemorrhage (ICH) (p=0.0001), symptomatic ICH (sICH) (p=0.0001) and early neurological deterioration (END) (p=0.007) were associated with FCR. Conclusion: Nearly half of patients in this national registry experienced FCR follow-ing EVT. Significant predictors of FCR included increasing age, admission NIHSS scores, pre-stroke disability, onset-to-puncture and procedural times, presence of diabetes, atrial fibrillation, and use of general anaesthesia. Post procedural develop-ment of any ICH, sICH, and END were associated with FCR.

引用

页数：6

共 15 条

[1] Predictors of futile recanalization after endovascular treatment in acute ischemic stroke: a meta-analysis [J].