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

Rob A. Van De Graaf*, Noor Samuels, Vicky Chalos, Geert J. Lycklama A Nijeholt, Heleen Van Beusekom, Albert J. Yoo, Wim H. Van Zwam, Charles B.L.M. Majoie, Yvo B.W.E.M. Roos, Pieter Jan Van Doormaal, Wagih Ben Hassen, Aad Van Der Lugt, Diederik W.J. Dippel, Hester F. Lingsma, Adriaan C.G.M. Van Es, Bob Roozenbeek

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)

Abstract

Background: Approximately 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. Methods: We 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. Results: Of 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. Conclusion: Baseline 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.

Original languageEnglish
Pages (from-to)660-665
Number of pages6
JournalJournal of NeuroInterventional Surgery
Volume14
Issue number7
Early online date15 Jul 2021
DOIs
Publication statusPublished - 2022

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