Discrepancy between early neurological course and mid-term outcome in older stroke patients after mechanical thrombectomy

BackgroundStroke in aged patients has a relatively poor prognosis, even after recanalizing therapy. Potential reasons include mechanisms that relate directly to the extent of brain tissue damage, but also age-dependent factors which are not, or only indirectly, stroke-related, such as pre-existing functional deficits, comorbidities, and post-stroke complications (eg, infections).ObjectiveTo compare early neurological course with subsequent functional outcome in older (≥80 years) and younger stroke patients in order to estimate the relative impact of these factors. Specifically, to examine if the strong age-dependency of modified Rankin Scale (mRS) outcome scores in stroke patients after mechanical thrombectomy is paralleled by a similar age dependency of early postinterventional National Institute of Health Stroke Scale (NIHSS) scores—a more specific measure of stroke-induced brain damage.MethodsWe evaluated technical results, pre- and postinterventional NIHSS scores, mid-term mRS scores and early and overall mortality and their relation to age in 125 patients, 40 of them ≥80 years, with acute middle cerebral artery occlusion, treated by mechanical thrombectomy.ResultsTechnical success, pre- and postinterventional NIHSS scores and early mortality were age-independent. Early neurological improvement depended on successful recanalization, but not on age. Nevertheless, good mRS outcome (mRS 0–2) was much rarer, and overall mortality almost threefold higher in aged patients.ConclusionsOlder patients exhibit a similar early neurological course and responsiveness to mechanical thrombectomy as younger patients, but this is not reflected in mid-term functional outcome scores. This indicates that post-stroke complications and other factors that are not, or only indirectly, related to the brain tissue damage induced by the incident stroke have a dominant role in their poor prognosis.

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Prediction of Functional Outcome in Patients with Acute Stroke by Measuring tRNA Derivatives

Cerebrovascular Diseases ◽

10.1159/000511627 ◽

2020 ◽

Vol 49 (6) ◽

pp. 639-646 ◽

Cited By ~ 1

Author(s):

Tomohisa Ishida ◽

Takashi Inoue ◽

Kuniyasu Niizuma ◽

Natsumi Konno ◽

Chitose Suzuki ◽

...

Keyword(s):

Ischemic Stroke ◽

Healthy Volunteers ◽

Functional Outcome ◽

Tissue Damage ◽

Noncoding Rna ◽

Hemorrhagic Stroke ◽

Stroke Patients ◽

Brain Tissue Damage ◽

Cell Stress Response ◽

Trna Derivatives

Background and Purpose: Transfer RNA (tRNA) is a noncoding RNA that delivers amino acids to ribosomes for protein synthesis. tRNA is also involved in cell stress response programs. Oxidative stress induces direct conformational change in tRNA structure that promotes subsequent tRNA fragmentation. Using an antibody against tRNA-specific modified nucleoside 1-methyladenosine (m1A), we can detect tRNA derivatives such as conformationally changed tRNA, tRNA-derived fragments, and mononucleotide-free m1A. Based on these findings, tRNA derivatives may have potential as an early tissue damage marker. The purpose of this study was to investigate the plasma tRNA derivatives in stroke patients to clarify whether tRNA derivatives in the acute phase can detect early brain damage and then predict the functional outcome. Methods: Patients (75 patients with ischemic and 66 with hemorrhagic stroke) and 22 healthy volunteers were prospectively enrolled for this study between November 2016 and February 2019. Plasma samples were collected within 24 h and at 1 day, 7 days, and 30 days from the onset. Plasma tRNA derivative concentrations were measured by ELISA kit using the anti-m1A antibody. Results: The plasma tRNA derivative level on admission was significantly increased in both ischemic (mean ± standard error, 232.2 ± 33.1 ng/mL) and hemorrhagic stroke patients (212 ± 23.4 ng/mL) compared to the healthy volunteers (86.0 ± 7.9 ng/mL) (p = 0.00042 and p = 0.00018, respectively). The infarction size (r = 0.445, p = 0.00018) and hematoma volumes (r = 0.33, p = 0.0072) were also significantly correlated with tRNA derivatives. The concentrations of tRNA derivatives were associated with poor functional outcome (Modified Rankin Scale score 3–6 at 30 days from the onset) in patients with ischemic stroke at 7 days after onset (p = 0.020). Conclusions: Stress-induced tRNA derivatives can detect brain tissue damage, predicting functional outcome in patients with ischemic stroke.

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Abstract TP19: Charlson Comorbidity Index Predicts Mortality and Functional Outcome in Acute Ischemic Stroke Patients Treated With Mechanical Thrombectomy

Stroke ◽

10.1161/str.47.suppl_1.tp19 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Daniela Samaniego ◽

Maria Hernandez-Perez ◽

Anna Planas ◽

Lorena Martin ◽

Laura Dorado ◽

...

Keyword(s):

Ischemic Stroke ◽

Functional Outcome ◽

Charlson Comorbidity Index ◽

Mechanical Thrombectomy ◽

Stroke Severity ◽

Stroke Patients ◽

Poor Functional Outcome ◽

Arterial Revascularization ◽

Comorbidity Index ◽

High Comorbidity

Introduction: Despite mechanical thrombectomy has achieved a dramatic improvement on ischemic stroke prognosis, up to 50% of patients treated with this approach do not have good functional outcome. Besides age and baseline infarct core, comorbidity might play a role in stroke prognosis. We aim to study the capacity of Charlson comorbidity index (CCI) in predicting mortality and functional outcome in acute ischemic stroke patients who underwent mechanical thrombectomy. Methods: We studied 228 consecutive patients (59% male, mean age 65y) with acute anterior circulation arterial occlusion treated with stent retrievers between May 2009 and March 2015. Demographical data, stroke severity, ASPECTS score at baseline and medical conditions included in the CCI were collected and CCI score was calculated retrospectively. We considered low comorbidity if CCI score was <2 and high comorbidity if CCI score was ≥2. Complete arterial revascularization was defined as a TICI ≥2b on final angiographic run. Good functional outcome was defined as a modified Rankin score ≤2 at 90 days. Results: The CCI was 0 in 47% of patients, 1 in 23%, 2 in 15%, 3 in 10% and ≥4 in 5%. CCI of 2 or more was associated with poor functional outcome (70.6% vs 50%, p = 0.004) and mortality (33.8% vs. 11.7%, p <0.001) compared to patients with low CCI. In a logistic regression adjusted by stroke severity, age, ASPECTS score at baseline and arterial revascularization, high comorbidity remained as an independent predictor of poor outcome (OR 2.9; 95% CI 1.4-5.8) and mortality (OR 4.6, 95% CI 2.0-10.3). Conclusions: High comorbidity assessed by Charlson Comorbidity Index is associated with poor functional outcome and mortality in acute stroke patients treated with mechanical thrombectomy.

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Blood Leukocytes as Prognostic Parameter in Stroke Thrombectomy

Cerebrovascular Diseases ◽

10.1159/000444369 ◽

2016 ◽

Vol 42 (1-2) ◽

pp. 32-40 ◽

Cited By ~ 7

Author(s):

Thomas Huber ◽

Justus F. Kleine ◽

Johannes Kaesmacher ◽

Stefanie Bette ◽

Holger Poppert ◽

...

Keyword(s):

Operating Characteristic ◽

Mechanical Thrombectomy ◽

White Blood Cells ◽

C Reactive Protein ◽

Stroke Patients ◽

Blood Leukocytes ◽

Reactive Protein ◽

Recent Success ◽

Outcome Scores ◽

Before And After

Purpose: Despite the recent success of mechanical thrombectomy (MT) in the treatment of acute ischemic stroke, prognostic parameters and criteria for patient selection are yet uncertain. Elevated levels of white blood cells (WBCs) constitute an independent risk factor for unfavorable outcome. Here we studied the link between outcome and WBC counts obtained before and after successful MT. Methods: One hundred fifteen acute stroke patients successfully treated with MT (thrombolysis in cerebral infarction-scores 2b or 3) were included. WBC counts and C-reactive protein (CRP) levels were obtained prior to (WBC-pre, CRP-pre) and 1 day after MT (WBC-post, CRP-post). Clinical outcome measures consisted of National Institute of Health Stroke Scale (NIHSS) scores, and modified Rankin Scale (mRS) on day 90 (mRS-d90), dichotomized between scores ≤5 and >5 (NIHSS) and ≤2 and >2 (mRS). The association between WBC-/CRP-levels and outcome was assessed by correlation- and receiver-operating characteristic analyses. Results: WBC counts on day 1 after MT correlated significantly with NIHSS scores at discharge and mRS-d90. Among patients >50 years, no patient with WBC-post counts exceeding 14.2 G/l had favorable NIHSS scores (≤5), and no one with WBC-post counts ≥12.6 G/l had favorable mRS-d90 outcome-scores (≤2). Further, even WBC-pre counts ≥10.6 G/l predicted unfavorable mRS-d90-scores in this subgroup. Conclusion: Elevated WBC counts obtained in routine blood tests may constitute a simple and economic parameter to estimate outcome after successful MT. Moreover, present data suggest that in patients older than 50 years, WBC counts may help to predict outcome even when obtained prior to MT.

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Role of S100B Serum Concentration as a Surrogate Outcome Parameter After Mechanical Thrombectomy

Neurology ◽

10.1212/wnl.0000000000012918 ◽

2021 ◽

pp. 10.1212/WNL.0000000000012918

Author(s):

Sebastian Luger ◽

Kimberly Koerbel ◽

Ariane Martinez Oeckel ◽

Hauke Schneider ◽

Christoph J. Maurer ◽

...

Keyword(s):

Ischemic Stroke ◽

Serum Concentration ◽

Infarct Size ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Tissue Damage ◽

Mechanical Thrombectomy ◽

Serum Concentrations ◽

Outcome Parameter ◽

Surrogate Outcome

Objective:To establish serum concentration of protein S100B as an objective biomarker surrogate for astroglial tissue damage after mechanical thrombectomy in patients with acute ischemic stroke.Methods:This prospective two-center study recruited patients with acute middle cerebral artery infarctions caused by large vessel occlusion treated with mechanical thrombectomy. Blood samples were collected at day 2 after intervention and analyzed for S100B serum concentrations using ELISA techniques. Infarct size was determined on follow-up brain imaging, and functional outcome according to modified Rankin scale (mRS) was assessed at 90 days.Results:171 patients were included (mean age ±SD: 70±14 years, 42% female). S100B levels correlated with infarct size. Median S100B concentrations at day 2 after intervention were lower in patients with favorable outcome (mRS score 0-1) at 90 days compared to patients with unfavorable outcome (mRS score 2-6) (median 0.10 µg/L [IQR 0.07-0.14] vs. 0.20 µg/L [0.11-0.48], p<0.001). Younger age (OR 1.120 [CI 1.068-1.174; p<0.001), lower NIHSS 24h after symptom onset (OR 1.232 [CI 1.106-1.372; p<0.001) and lower S100B serum concentrations (OR 1.364 [CI 1.105-1.683]; p=0.004) were independently associated with a favorable outcome. S100B was able to eliminate the lateralization bias associated with the use of mRS for functional outcome assessment at 90 days after stroke.Conclusion:S100B serum concentrations after mechanical thrombectomy indicate the extent of ischemic tissue damage. It can be rapidly assessed, independent of brain imaging and clinical outcome scales. Following prospective validation in further studies, it may provide an objective surrogate outcome parameter both in clinical routine and interventional trials.Classification of Evidence:This study provides Class I evidence that S100B 2 days following mechanical thrombectomy for acute ischemic stroke accurately distinguishes favorable from unfavorable functional outcome.

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Carotid Artery Perivascular Adipose Tissue Density Relates to Recanalization and Clinical Outcome After Mechanical Thrombectomy

Frontiers in Aging Neuroscience ◽

10.3389/fnagi.2021.761248 ◽

2021 ◽

Vol 13 ◽

Author(s):

Jiaolei Jin ◽

Rui Huang ◽

Qiuyue Chen ◽

Boxi Ke ◽

Taotao Tao ◽

...

Keyword(s):

Adipose Tissue ◽

Carotid Artery ◽

Functional Outcome ◽

Mechanical Thrombectomy ◽

Surrogate Marker ◽

Independent Effect ◽

Large Artery ◽

Stroke Patients ◽

Vessel Occlusion ◽

Perivascular Adipose Tissue

Background: Perivascular adipose tissue (PVAT) imaging can be used in clinical practice as a surrogate marker of vascular disease. We aimed to analyze the association between the density of carotid artery PVAT and clinical features and outcomes in stroke patients treated with mechanical thrombectomy.Methods: A total of 183 consecutive patients treated with mechanical thrombectomy due to anterior circulation large vessel occlusion were retrospectively included from January 2016 to May 2021. The density of carotid artery PVAT was evaluated by preoperative computed tomography angiography. Successful arterial recanalization was defined as a modified Thrombolysis in Cerebral Infarction score of 2b-3 on the final angiographic examination. Poor functional outcome was defined as a modified Rankin Scale (mRS) score > 2 at 3 months after stroke. We assessed the independent effect of carotid artery PVAT density on revascularization, functional outcome, and mortality using logistic regression models adjusted for relevant confounders.Results: Patients with large artery atherosclerotic stroke have higher carotid artery PVAT density than patients with other stroke etiologies (–65.82 ± 12.96 vs. –75.77 ± 13.44, P < 0.001). Higher carotid artery PVAT density was associated with unsuccessful recanalization [adjusted odds ratio (AOR) (95% CI), 2.968 (1.292, 6.819), P = 0.010], and poor outcome [AOR (95% CI), 2.704 (1.610, 4.541), P < 0.001] and mortality [AOR (95% CI), 1.894 (1.040, 3.449), P = 0.037] at 3 months in stroke patients treated with thrombectomy.Conclusion: Higher carotid artery PVAT density before mechanical thrombectomy is an indicator of worse postprocedural arterial revascularization and a worse functional outcome in acute stroke patients.

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Necrostatin-1 Reduces Histopathology and Improves Functional Outcome after Controlled Cortical Impact in Mice

Journal of Cerebral Blood Flow & Metabolism ◽

10.1038/jcbfm.2008.44 ◽

2008 ◽

Vol 28 (9) ◽

pp. 1564-1573 ◽

Cited By ~ 186

Author(s):

Zerong You ◽

Sean I Savitz ◽

Jinsheng Yang ◽

Alexei Degterev ◽

Junying Yuan ◽

...

Keyword(s):

Dentate Gyrus ◽

Functional Outcome ◽

Tissue Damage ◽

Therapeutic Potential ◽

Specific Inhibitor ◽

Experimental Stroke ◽

Necrosis Factor Alpha ◽

Controlled Cortical Impact ◽

Cortical Impact ◽

Brain Tissue Damage

Necroptosis is a newly identified type of programmed necrosis initiated by the activation of tumor necrosis factor alpha (TNFα)/Fas. Necrostatin-1 is a specific inhibitor of necroptosis that reduces ischemic tissue damage in experimental stroke models. We previously reported decreased tissue damage and improved functional outcome after controlled cortical impact (CCI) in mice deficient in TNFα and Fas. Hence, we hypothesized that necrostatin-1 would reduce histopathology and improve functional outcome after CCI in mice. Compared with vehicle-/inactive analog-treated controls, mice administered necrostatin-1 before CCI had decreased propidium iodide-positive cells in the injured cortex and dentate gyrus (6 h), decreased brain tissue damage (days 14, 35), improved motor (days 1 to 7), and Morris water maze performance (days 8 to 14) after CCI. Improved spatial memory was observed even when drug was administered 15 mins after CCI. Necrostatin-1 treatment did not reduce caspase-3-positive cells in the dentate gyrus or cortex, consistent with a known caspase-independent mechanism of necrostatin-1. However, necrostatin-1 reduced brain neutrophil influx and microglial activation at 48 h, suggesting a novel anti-inflammatory effect in traumatic brain injury (TBI). The data suggest that necroptosis plays a significant role in the pathogenesis of cell death and functional outcome after TBI and that necrostatin-1 may have therapeutic potential for patients with TBI.

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Elevated Red Blood Cell Distribution Width May Be a Novel Independent Predictor of Poor Functional Outcome in Patients Treated with Mechanical Thrombectomy

Neurointervention ◽

10.5469/neuroint.2020.00262 ◽

2020 ◽

Author(s):

Cetin Kursad Akpinar ◽

Erdem Gurkaş ◽

Ozlem Aykac ◽

Zehra Uysal ◽

Atilla Ozcan Ozdemir

Keyword(s):

Ischemic Stroke ◽

Functional Outcome ◽

Functional Outcomes ◽

Mechanical Thrombectomy ◽

Independent Predictor ◽

Cell Distribution ◽

Stroke Patients ◽

Poor Functional Outcome ◽

Distribution Width ◽

Red Blood Cell Distribution

Purpose: Red blood cell distribution width (RDW) evaluates the variation (size heterogeneity) in red blood cells. Elevated RDW has been identified as a predictor of poor functional outcomes for acute ischemic stroke. The association between elevated RDW level and poor functional outcome in stroke patients undergoing mechanical thrombectomy has not been reported before. This study aims to investigate this relationship.Materials and Methods: This was a multicenter retrospective study involving the prospectively and consecutively collected data of 205 adult stroke patients who underwent mechanical thrombectomy for anterior circulation large vessel occlusion (middle cerebral artery M1, anterior cerebral artery A1, tandem ICA-MCA, carotid T) between July 2017 and December 2019. RDW cut off levels were accepted as >16%. The effect of elevated RDW on poor functional outcome (modified Rankin scale 3–6) was investigated using bivariate and multivariate regression analysis.Results: Elevated RDW was significantly associated with poor functional outcome in bivariate and multivariate analysis (odds ratio [OR] for RDW >16%, 2.078; 95% confidence interval [95% CI], 1.083–3.966; P=0.027 and OR for RDW >16%, 2.873; 95% CI, 1.342–6.151; P=0.007; respectively).Conclusion: These findings suggest that elevated RDW may be an independent predictor of poor functional outcomes in ischemic stroke patients undergoing mechanical thrombectomy.

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Leukoaraiosis severity and outcomes after mechanical thrombectomy with stent-retriever devices in acute ischemic stroke

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014018 ◽

2018 ◽

Vol 11 (2) ◽

pp. 137-140 ◽

Cited By ~ 7

Author(s):

Yongtao Guo ◽

Wenjie Zi ◽

Yue Wan ◽

Shuai Zhang ◽

Bo Sun ◽

...

Keyword(s):

Acute Stroke ◽

Functional Outcome ◽

Mechanical Thrombectomy ◽

Multivariable Analysis ◽

Stent Retriever ◽

National Institutes Of Health ◽

Stroke Patients ◽

Good Functional Outcome ◽

Negative Predictor ◽

Retrospective Multicenter Study

Background and purposeThe aim of the study was to evaluate whether leukoaraiosis severity is associated with outcome in acute stroke patients undergoing mechanical thrombectomy with stent-retriever devices.MethodsIn this retrospective multicenter study, we evaluated 251 acute stroke patients (pretreatment National Institutes of Health Stroke Scale score ≥8) treated with stent-retriever devices. Leukoaraiosis severity was graded as 0–2 (absent-to-moderate) versus 3–4 (severe) according to the van Swieten scale. The main clinical outcome was the proportion of good functional outcome, defined as a modified Rankin Scale of 0–2 at 90 days.ResultsSignificantly fewer patients in the severe LA group than in the absent-to-moderate LA group achieved a good functional outcome (18.4% vs 50.2%, P<0.001). In multivariable analysis, severe leukoaraiosis was a significant negative predictor of good functional outcome at 90 days (OR, 0.27; 95% CI 0.10–0.77; P=0.014).ConclusionsThe severity of leukoaraiosis is independently associated with 90-day functional outcome in acute stroke patients undergoing mechanical thrombectomy with stent-retriever devices.

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Monocytes carrying GFAP detect glioma, brain metastasis and ischemic stroke, and predict glioblastoma survival

Brain Communications ◽

10.1093/braincomms/fcaa215 ◽

2020 ◽

Author(s):

Wouter B L van den Bossche ◽

Arnaud J P E Vincent ◽

Cristina Teodosio ◽

Jeroen Koets ◽

Aladdin Taha ◽

...

Keyword(s):

Ischemic Stroke ◽

Brain Metastasis ◽

Acute Ischemic Stroke ◽

Tissue Damage ◽

Disease Monitoring ◽

Multiple Time ◽

Blood Monocytes ◽

Stroke Patients ◽

Multiple Time Points ◽

Brain Tissue Damage

Abstract Diagnosis and monitoring of primary brain tumours, brain metastasis and acute ischemic stroke all require invasive, burdensome and costly diagnostics, frequently lacking adequate sensitivity, particularly during disease monitoring. Monocytes are known to migrate to damaged tissues, where they act as tissue macrophages, continuously scavenging, phagocytizing, and digesting apoptotic cells and other tissue debris. We hypothesize that upon completion of their tissue-cleaning task, these tissue macrophages might migrate via the lymph system to the bloodstream, where they can be detected and evaluated for their phagolysosomal contents. We discovered a blood monocyte subpopulation carrying the brain-specific glial fibrillary acidic protein (GFAP) in glioma patients and in patients with brain metastasis and evaluated the diagnostic potential of this finding. Blood samples were collected in a cross-sectional study before or during surgery from adult patients with brain lesions suspected of glioma. Together with blood samples from healthy controls, these samples were flow cytometrically evaluated for intracellular GFAP in monocyte subsets. Acute ischemic stroke patients were tested at multiple time points after onset to evaluate the presence of GFAP-carrying monocytes in other forms of brain-tissue damage. Clinical data was collected retrospectively. High-grade gliomas (N = 145), brain metastasis (N = 21) and large stroke patients (>100cm3)(N = 3 vs. 6; multiple time points) had significantly increased frequencies of GFAP+CD16+ monocytes compared to healthy controls. Based on both a training and validation set, a cut-off value of 0.6% GFAP+CD16+ monocytes was established, with 81% sensitivity (95%CI 75%-87%) and 85% specificity (95%CI 80%-90%) for brain lesion detection. Acute ischemic strokes of > 100 cm3 reached >0.6% of GFAP+CD16+ monocytes within the first 2-8 hours after hospitalisation and subsided within 48 hours. Glioblastoma patients with >20% GFAP+CD16+ non-classical monocytes had a significantly shorter median overall survival (8.1 vs 12.1 months). Our results and the available literature, support the hypothesis of a tissue-origin of these GFAP-carrying monocytes. Blood monocytes carrying GFAP have a high sensitivity and specificity for detection of brain lesions and for glioblastoma patients with a decreased overall survival. Furthermore, their very rapid response to acute tissue damage identifies large areas of ischemic tissue damage within 8 hours after an ischemic event. These studies are the first to report the clinical applicability for brain tissue damage detection through a minimal invasive diagnostic method, based on blood monocytes and not serum markers, with direct consequences for disease monitoring in future (therapeutic) studies and clinical decision making in glioma and acute ischemic stroke patients.

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Moderate to Severe Anemia Is Associated with Poor Functional Outcome in Acute Stroke Patients Treated with Mechanical Thrombectomy

Interventional Neurology ◽

10.1159/000480642 ◽

2017 ◽

Vol 7 (1-2) ◽

pp. 12-18 ◽

Cited By ~ 2

Author(s):

Cetin Kursad Akpinar ◽

Erdem Gurkas ◽

Emrah Aytac

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Functional Outcome ◽

Clinical Outcomes ◽

Mechanical Thrombectomy ◽

Multiple Logistic Regression Analysis ◽

Severe Anemia ◽

Stroke Patients ◽

Poor Functional Outcome ◽

Moderate Anemia

Background: Anemia will negatively affect cerebral collaterals and penumbra. Eventually, it may cause worse clinical outcomes and even increase mortality rates in stroke patients. Anemia has recently been suggested to be an independent risk factor for ischemic stroke. Therefore, we aimed to investigate the effects of the presence of anemia on clinical outcomes in ischemic stroke patients undergoing mechanical thrombectomy. Methods: This was a retrospective study involving the prospectively and consecutively collected data of 90 adult patients between January 2015 and August 2016. Hemoglobin (Hb) cutoff levels were accepted as 12 g/dL for women and 13 g/dL for men. Patients having anemia were further divided into three subgroups as severe anemia (Hb <8 g/dL for both genders), moderate anemia (Hb <10 g/dL for both genders), and mild anemia (Hb <13 g/dL for men and Hb <12 g/dL for women). Results: Forty of the subjects (44.4%) had anemia. Moderate anemia was detected in 14 out of 90 patients (15.5%) and severe anemia was found in only four of them (4.4%). Poor functional outcome (mRS 3-6) was similar in both anemic and non-anemic patients (37.5% vs. 38%, respectively, p = 0.08), but poor functional outcome was found to be statistically significant with severe anemic group (Hb <8 mg/dL) (p = 0.003). In multiple logistic regression analysis, moderate and severe anemia has been found to increase the mortality (p = 0.032). Conclusions: Our study demonstrated a poor functional outcome only in moderate to severe anemic patients. Clinicians should keep in mind the negative effect of moderate to severe anemia in the clinical course of acute stroke patients treated with mechanical thrombectomy.

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