Factors associated with unfavorable outcome of anterior circulation ischemic stroke following emergency endovascular therapy after complete recanalization

Authors

  • Chunchao Yang Central People’s Hospital of Zhanjiang
  • Jamir Pitton Rissardo Neurology Department, Cooper University Hospital, NJ 08103, USA
  • Ana Letícia Fornari Caprara Medicine Department, Federal University of Santa Maria, RS 97105110, Brazil
  • Durga Neupane Department of Surgery, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
  • Yueming Chen Department of Emergency Medicine， Central People’s Hospital of Zhanjiang, Zhanjiang, Guangdong Province, China.
  • Chandi Li Department of Neurology， Central People’s Hospital of Zhanjiang, Zhanjiang, Guangdong Province, China.
  • Zhenzhang Li College of Mathematics and Systems Science,Guangdong Polytechnic Normal University, Guangzhou，China School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou, China.
  • Junjie Gao Department of Neurology， Central People’s Hospital of Zhanjiang, Zhanjiang, Guangdong Province, China.
  • Longchong Tang Department of Neurology， Central People’s Hospital of Zhanjiang, Zhanjiang, Guangdong Province,
  • Qingwen Yu ,Department of Neurosurgery， Central People’s Hospital of Zhanjiang, Zhanjiang, Guangdong Province,
  • Yuhang Liang Department of Neurology， Central People’s Hospital of Zhanjiang, Zhanjiang, Guangdong Province, China.

DOI:

https://doi.org/10.54029/2024scr

Keywords:

recanalization, unfavorable, ischemic stroke, endovascular therapy, thrombectomy

Abstract

Objective: Endovascular thrombectomy (EVT) improves long-term patients outcomes and decreases mortality among ischemic stroke patients. However, not all patients can benefit from EVT recanalization. The present study aims to evaluate the predictors of unfavorable outcomes associated with emergency endovascular therapy despite complete recanalization.

Methods: We investigated 74 eligible patients receiving EVT from January 2019 to January 2022 at a comprehensive stroke center. Demographics, clinical, radiological and treatment characteristics, safety, and functional outcomes were collected. Modified Rankin scale (mRS) score ≤ 2 at 90 days was defined as a good functional outcome.

Results: A total of 111 patients were initially eligible for the study, of which 37 were excluded, resulting in 74 patients in the final study. The mean age was 69.08±12.12 years old, 67.57% patients were male, 44.59% patients with atrial fibrillation, 64.86% with hypertension, 21.62% patients with diabetes mellitus, 16.22% patients with coronary artery diseases, 6.76% with parenchymal hematoma. Median pre-EVT NIHSS (IQR) was 15.5 (12.0, 19.25). Median door-to-recanalization time (DRT) (IQR) was 208.0 (160.0,278.5) minutes and median last known norma to puncture time (LKNPT) (IQR), was 362.0 (280, 452.5) minutes. Individuals with a poorer outcome were older [73.56±9.29 vs. 65.28±13.02 years old, P=0.002], had a higher prevalence of atrial fibrillation (AF) [58.82 vs. 13%, P=0.023] and a higher National Institute of Health Stroke Scale (NIHSS) [median 16 (IQR 12.0-22.3) vs median 15 (IQR 10.0-18.0), P=0.143]. Female sex, hypertension, diabetes mellitus, coronary artery disease, and a slightly longer door-to-recanalization time were more prevalent in the unfavorable prognosis group; however, statistical analysis did not show any significant differences. Logistics binary regression model showed that older age [OR: 0.1.160 (1.011 to 1.112, P=0.031)] and AF [OR: 3.190 (1.111 to 9.164, P=0.031)] were associated with an unfavorable outcome.

Conclusion: Older age, and atrial fibrillation were factors associated with the unfavorable outcome despite complete recanalization after emergency EVT of ischemic stroke.

Published

2024-10-05

Issue

Vol. 29 No. 3 (2024)

Section

Original Article