Predictors of functional dependence despite successful revascularization in large-vessel occlusion strokes

Zhong Song Shi, David S. Liebeskind, Bin Xiang, Sijian Grace Ge, Lei Feng, Gregory W. Albers, Ronald Budzik, Thomas Devlin, Rishi Gupta, Olav Jansen, Tudor G. Jovin, Monika Killer-Oberpfalzer, Helmi L. Lutsep, Juan Macho, Raul G. Nogueira, Marilyn Rymer, Wade S. Smith, Nils Wahlgren, Gary R. Duckwiler

Research output: Contribution to journalArticle

51 Scopus citations

Abstract

BACKGROUND AND PURPOSE - : High revascularization rates in large-vessel occlusion strokes treated by mechanical thrombectomy are not always associated with good clinical outcomes. We evaluated predictors of functional dependence despite successful revascularization among patients with acute ischemic stroke treated with thrombectomy. METHODS - : We analyzed the pooled data from the Multi Mechanical Embolus Removal in Cerebral Ischemia (MERCI), Thrombectomy Revascularization of Large Vessel Occlusions in Acute Ischemic Stroke (TREVO), and TREVO 2 trials. Successful revascularization was defined as thrombolysis in cerebral infarction score 2b or 3. Functional dependence was defined as a score of 3 to 6 on the modified Rankin Scale at 3 months. We assessed relationship of demographic, clinical, angiographic characteristics, and hemorrhage with functional dependence despite successful revascularization. RESULTS - : Two hundred and twenty-eight patients with successful revascularization had clinical outcome follow-up. The rates of functional dependence with endovascular success were 48.6% for Trevo thrombectomy and 58.0% for Merci thrombectomy. Age (odds ratio, 1.04; 95% confidence interval, 1.02-1.06 per 1-year increase), National Institutes of Health Stroke Scale score (odds ratio, 1.08; 95% confidence interval, 1.02-1.15 per 1-point increase), and symptom onset to endovascular treatment time (odds ratio, 1.11; 95% confidence interval, 1.01-1.22 per 30-minute delay) were predictors of functional dependence despite successful revascularization. Symptom onset to reperfusion time beyond 5 hours was associated with functional dependence. All subjects with symptomatic intracranial hemorrhage had functional dependence. CONCLUSIONS - : One half of patients with successful mechanical thrombectomy do not have good outcomes. Age, severe neurological deficits, and delayed endovascular treatment were associated with functional dependence despite successful revascularization. Our data support efforts to minimize delays to endovascular therapy in patients with acute ischemic stroke to improve outcomes.

Original languageEnglish (US)
Pages (from-to)1977-1984
Number of pages8
JournalStroke
Volume45
Issue number7
DOIs
StatePublished - Jul 2014

Keywords

  • stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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    Shi, Z. S., Liebeskind, D. S., Xiang, B., Ge, S. G., Feng, L., Albers, G. W., Budzik, R., Devlin, T., Gupta, R., Jansen, O., Jovin, T. G., Killer-Oberpfalzer, M., Lutsep, H. L., Macho, J., Nogueira, R. G., Rymer, M., Smith, W. S., Wahlgren, N., & Duckwiler, G. R. (2014). Predictors of functional dependence despite successful revascularization in large-vessel occlusion strokes. Stroke, 45(7), 1977-1984. https://doi.org/10.1161/STROKEAHA.114.005603