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
Dhillon, Permesh Singh
Butt, Waleed
Marei, Omar
Podlasek, Anna
McConachie, Norman
Lenthall, Robert
Nair, Sujit
Malik, Luqman
Bhogal, Pervinder
Makalanda, Hegoda Levansri Dilrukshan
Citations
Altmetric:
Affiliation
Other Contributors
Publication date
2023-03-15
Subject
Collections
Research Projects
Organizational Units
Journal Issue
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 PS, Butt W, Marei O, Podlasek A, McConachie N, Lenthall R, Nair S, Malik L, Bhogal P, Makalanda HLD, Dineen RA, England TJ. Incidence and predictors of poor functional outcome despite complete recanalisation following endovascular thrombectomy for acute ischaemic stroke. J Stroke Cerebrovasc Dis. 2023 May;32(5):107083. doi: 10.1016/j.jstrokecerebrovasdis.2023.107083. Epub 2023 Mar 15.
Type
Article