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

Dhillon, Permesh Singh; Butt, Waleed; Marei, Omar; Podlasek, Anna; McConachie, Norman; Lenthall, Robert; Nair, Sujit; Malik, Luqman; Bhogal, Pervinder; Makalanda, Hegoda Levansri Dilrukshan; Dineen, Robert A.; England, Timothy J.

Abstract

Background: Numerous ischaemic stroke patients experience poor functional outcome despite successful recanalisation following endovascular thrombectomy (EVT). We aimed to identify the incidence and predictors of futile complete recanalisation (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 dependent 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 confounders, 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 following 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 development of any ICH, sICH, and END were associated with FCR.

Citation

Dhillon, P. S., Butt, W., Marei, O., Podlasek, A., McConachie, N., Lenthall, R., …England, T. J. (2023). Incidence and predictors of poor functional outcome despite complete recanalisation following endovascular thrombectomy for acute ischaemic stroke. Journal of Stroke and Cerebrovascular Diseases, 32(5), Article 107083. https://doi.org/10.1016/j.jstrokecerebrovasdis.2023.107083

• Journal Article Type: Article
• Acceptance Date: Mar 8, 2023
• Online Publication Date: Mar 15, 2023
• Publication Date: 2023-05
• Deposit Date: Mar 13, 2023
• Publicly Available Date: Mar 16, 2024
• Journal: Journal of Stroke and Cerebrovascular Diseases
• Print ISSN: 1052-3057
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 32
• Issue: 5
• Article Number: 107083
• DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2023.107083
• Keywords: Endovascular thrombectomy, symptomatic intracranial hemorrhage, early neurological deterioration, computed tomography, Stroke
• Public URL: https://nottingham-repository.worktribe.com/output/18491692
• Publisher URL: https://www.strokejournal.org/article/S1052-3057(23)00107-6/fulltext
• Additional Information: This article is maintained by: Elsevier; Article Title: Incidence and predictors of poor functional outcome despite complete recanalisation following endovascular thrombectomy for acute ischaemic stroke; Journal Title: Journal of Stroke and Cerebrovascular Diseases; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.jstrokecerebrovasdis.2023.107083; Content Type: article; Copyright: © 2023 The Authors. Published by Elsevier Inc.