Impact of Repeated Clot Retrieval Attempts on Infarct Growth and Outcome After Ischemic Stroke

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012321
Author(s):  
Wagih Ben Hassen ◽  
Caroline Touloupas ◽  
Joseph Benzakoun ◽  
Gregoire Boulouis ◽  
Martin Bretzner ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Functional Outcome ◽  
Mechanical Thrombectomy ◽  
Binary Logistic Regression ◽  
Unfavorable Outcome ◽  
Binary Logistic Regression Analysis ◽  
Strongly Correlated ◽  
Vessel Occlusion

Objective:To determine whether the association between increasing number of clot retrieval attempts (CRA) and unfavorable outcome is due to an increase in emboli to new territory (ENT) and greater infarct growth (IG) in successfully recanalized patients with acute ischemic stroke due to large vessel occlusion (AIS LVO).Methods:Data were extracted from two pooled multicentric prospective registries of consecutive anterior AIS-LVO patients treated with mechanical thrombectomy (MT) between January 2016-2019. Patients with pretreatment and 24 hours post-treatment diffusion-weighted imaging (DWI) achieving successful recanalization, defined as expanded Thrombolysis in Cerebral Infarction Scale (eTICI) scores 2b, 2C or 3 were included. ENT were assessed and IG measured by voxel-based segmentation after DWI co-registration. Associations between number of CRA, ENT, IG and 3-month outcome were analyzed.Results:Four hundred nineteen patients achieving successful recanalization were included. ENT occurrence was strongly correlated with increasing CRA (ρ=0.73, p=10-4). In multivariable linear analysis, IG was independently associated with CRA (β=1.6 per retrieval attempt, 95% CI = [0.97–9.74], p=0.03) and ENT (β=2.7, [1.21-4.1], p=0.03). Unfavorable functional outcome (3-month modified Rankin Score >2) increased with each additional CRA. IG was an independent predictor of unfavorable outcome (OR=1.05 [1.02-1.07] per 1 mL IG increase, p=10-4) in binary logistic regression analysis.Conclusion:Increasing number of CRA in acute stroke is correlated with an increased ENT rate and increased IG volume, affecting functional outcome even when successful recanalization is achieved.Classification of evidence:This study provides Class II evidence that, for patients with acute stroke undergoing successful recanalization, an increasing number of clot retrieval attempts is associated with poorer functional outcome.

Abstract 3263: Cystatin C is Associated with Early Functional Outcome in Acute Stroke Patients

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Mi-Young Oh ◽  
Seung-Hoon Lee ◽  
Chi Kyung Kim ◽  
Sang-Bae Ko ◽  
Beom Joon Kim ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Functional Outcome ◽  
Cystatin C ◽  
Unfavorable Outcome ◽  
Stroke Patients ◽  
Kidney Dysfunction ◽  
Nihss Score ◽  
Hb A1c ◽  
Early Functional Outcome

Background: Cystatin C, a competitive inhibitor of lysosomal cysteine protease, is regarded as a sensitive marker of kidney dysfunction. Lower estimated glomerular filtration rate (eGFR) was associated with poor prognosis and all cause of mortality in stroke patients. Cystatin C was a more sensitive and accurate marker to detect subclinical kidney dysfunction, compared to creatinine, or creatinine based eGFR. We evaluated whether Cystatin C would predict functional outcome, independent of eGFR level in ischemic stroke. Methods: We evaluate consecutive patients with acute stroke who were admitted to Seoul National University Hospital between January 2008 and May 2011. We defined the unfavorable outcome group as containing each patient with a discharge mRS score of 1 with admission NIHSS score of 0 to 7, a discharge mRS score of 2 with admission NIHSS score 8 to 14, or a discharge mRS score of ≥3 with admission NIHSS score 15. Results: Among the total patients, 544(76.2%) patients had unfavorable outcome at discharge. Participants with unfavorable outcome tended to be female, older and to have higher Cystatin C, CRP, fibrinogen and Hb A1c concentrations. The proportion of patient with unfavorable outcome was gradually increased according to the cystatin C quartile. Compared to the lowest quartile of Cystatin C (47.2<nmol/L), higher quartiles (47.2 -54.7, 54.7-65.7, 65.7≥nmol/L) were likely to have a higher chance of unfavorable outcome [adjusted OR (95%CI), 1.55(0.73-3.31), 2.66 (1.21-5.87) and 2.84(1.15-7.09)] after adjusting for age, diabetes, Hb A1c, fibrinogen, CRP, NIHSS scale on admission, hemorrhagic transformation, IV thrombolytic treatment. In contrast, eGFR did not show any significant association with unfavorable outcome. Compared to the lowest category of eGFR (≥60 ml/min/1.73m2), higher categories (45.0- 60.0, 15.0-45.0, ≤15.0 ml/min/1.73m2) did not show significant association with unfavorable outcome. Conclusions: An increased level of Cystatin C was associated with functional outcome in stroke patients. Cystatin C may be a potent predictor to predictor of functional outcome after ischemic stroke.

scholarly journals Effectiveness of mechanical thrombectomy in cancer-related stroke and associated factors with unfavorable outcome

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Eung-Joon Lee ◽  
Jeonghoon Bae ◽  
Hae-Bong Jeong ◽  
Eun Ji Lee ◽  
Han-Yeong Jeong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Mechanical Thrombectomy ◽  
Elevated Serum ◽  
Unfavorable Outcome ◽  
Control Group ◽  
Nihss Score ◽  
And Control ◽  
D Dimer

Abstract Background The effectiveness of mechanical thrombectomy (MT) in cancer-related stroke (CRS) is largely unknown. This study aims to investigate the clinical and radiological outcomes of MT in CRS patients. We also explored the factors that independently affect functional outcomes of patients with CRS after MT. Methods We retrospectively reviewed 341 patients who underwent MT after acute ischemic stroke onset between May 2014 and May 2020. We classified the patients into CRS (n = 34) and control (n = 307) groups and compared their clinical details. Among CRS patients, we analyzed the groups with and without good outcomes (3-months modified Rankin scale [mRS] score 0, 1, 2). Multivariate analysis was performed to investigate the independent predictors of unfavorable outcomes in patients with CRS after MT. Results A total of 341 acute ischemic stroke patients received MT, of whom 34 (9.9%) had CRS. Although the baseline National institute of health stroke scale (NIHSS) score and the rate of successful recanalization was not significantly different between CRS patients and control group, CRS patients showed more any cerebral hemorrhage after MT (41.2% vs. controls 23.8%, p = 0.037) and unfavorable functional outcome at 3 months (CRS patients median 3-month mRS score 4, interquartile range [IQR] 2 to 5.25 vs. controls median 3-month mRS score 3, IQR 1 to 4, [p = 0.026]). In the patients with CRS, elevated serum D-dimer level and higher baseline NIHSS score were independently associated with unfavorable functional outcome at 3 months (adjusted odds ratio [aOR]: 1.524, 95% confidence interval [CI]: 1.043–2.226; aOR: 1.264, 95% CI: 1.010–1.582, respectively). Conclusions MT is an appropriate therapeutic treatment for revascularization in CRS patients. However, elevated serum D-dimer levels and higher baseline NIHSS scores were independent predictors of unfavorable outcome. Further research is warranted to evaluate the significance of these predictors.

scholarly journals Mechanical thrombectomy for acute ischemic stroke with cerebral microbleeds

2015 ◽  
Vol 8 (6) ◽  
pp. 563-567 ◽  
Author(s):  
Zhong-Song Shi ◽  
Gary R Duckwiler ◽  
Reza Jahan ◽  
Satoshi Tateshima ◽  
Nestor R Gonzalez ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Intravenous Thrombolysis ◽  
Cerebral Microbleeds ◽  
Vessel Occlusion ◽  
Gradient Recall Echo ◽  
Increased Risk

BackgroundThe influence of cerebral microbleeds (CMBs) on post-thrombolytic hemorrhagic transformation (HT) in patients with acute ischemic stroke remains controversial.ObjectiveTo investigate the association of CMBs with HT and clinical outcomes among patients with large-vessel occlusion strokes treated with mechanical thrombectomy.MethodsWe analyzed patients with acute stroke treated with Merci Retriever, Penumbra system or stent-retriever devices. CMBs were identified on pretreatment T2-weighted, gradient-recall echo MRI. We analyzed the association of the presence, burden, and distribution of CMBs with HT, procedural complications, in-hospital mortality, and clinical outcome.ResultsCMBs were detected in 37 (18.0%) of 206 patients. Seventy-three foci of microbleeds were identified. Fourteen patients (6.8%) had ≥2 CMBs, only 1 patient had ≥5 CMBs. Strictly lobar CMBs were found in 12 patients, strictly deep CMBs in 12 patients, strictly infratentorial CMBs in 2 patients, and mixed CMBs in 11 patients. There were no significant differences between patients with CMBs and those without CMBs in the rates of overall HT (37.8% vs 45.6%), parenchymal hematoma (16.2% vs 19.5%), procedure-related vessel perforation (5.4% vs 7.1%), in-hospital mortality (16.2% vs 18.3%), and modified Rankin Scale score 0–3 at discharge. CMBs were not independently associated with HT or in-hospital mortality in patients treated with either thrombectomy or intravenous thrombolysis followed by thrombectomy.ConclusionsPatients with CMBs are not at increased risk for HT and mortality following mechanical thrombectomy for acute stroke. Excluding such patients from mechanical thrombectomy is unwarranted. The risk of HT in patients with ≥5 CMBs requires further study.

scholarly journals Predictor of 90-day functional outcome after mechanical thrombectomy for large vessel occlusion stroke: NIHSS score of 10 or less at 24 hours

2019 ◽  
pp. 1-7
Author(s):  
Mirja M. Wirtz ◽  
Philipp Hendrix ◽  
Oded Goren ◽  
Lisa A. Beckett ◽  
Heather R. Dicristina ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Functional Outcome ◽  
Mechanical Thrombectomy ◽  
Characteristic Curve ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Nihss Score ◽  
Neurological Improvement ◽  
Good Functional Outcome

OBJECTIVEMechanical thrombectomy is the established treatment for acute ischemic stroke due to large vessel occlusion (LVO). The authors sought to identify early predictors of a favorable outcome in stroke patients treated with mechanical thrombectomy.METHODSConsecutive patients with ischemic stroke due to LVO who underwent mechanical thrombectomy at a Comprehensive Stroke Center in the US between 2016 and 2018 were retrospectively reviewed. Demographics, stroke and treatment characteristics, as well as functional outcome at 90 days were collected. Clinical predictors of 90-day functional outcome were assessed and compared to existing indices for prompt neurological improvement. Analyses of area under the receiver operating characteristic curve were performed to estimate the optimal thresholds for absolute 24-hour and delta (change in) National Institutes of Health Stroke Scale (NIHSS) scores for functional outcome prediction.RESULTSA total of 156 patients (median age 71.5 years) underwent 159 mechanical thrombectomies. The M1 segment of the middle cerebral artery was the most frequent site of occlusion (57.2%). The median NIHSS score before thrombectomy was 18 (IQR 14–24). A postthrombectomy Thrombolysis in Cerebral Infarction score of 2B or 3 was achieved in 147 procedures (92.4%). The median NIHSS score 24 hours after thrombectomy was 14 (IQR 6–22). Good functional outcome at 90 days (modified Rankin Scale score 0–2) was achieved in 37 thrombectomies (23.9%). An absolute 24-hour NIHSS score ≤ 10 (OR 25.929, 95% CI 8.448–79.582, p < 0.001) and a delta NIHSS score ≥ 8 between baseline and 24 hours (OR 4.929, 95% CI 2.245–10.818, p < 0.001) were associated with good functional outcome at 90 days. The 24-hour NIHSS score cutoff of 10 outperformed existing indices for prompt neurological improvement in the ability to predict 90-day functional outcome.CONCLUSIONSAn NIHSS score ≤ 10 at 24 hours after mechanical thrombectomy was independently associated with good functional outcome at 90 days.

Implications of the use of mechanical thrombectomy on outcome in large vessel occlusion following the 2015 landmark trials

2020 ◽  
Vol 13 (1) ◽  
pp. 4-7
Author(s):  
Okkes Kuybu ◽  
Vijayakumar Javalkar ◽  
Abdallah Amireh ◽  
Arshpreet Kaur ◽  
Roger E Kelley ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Intravenous Thrombolysis ◽  
Binary Logistic Regression ◽  
Standard Of Care ◽  
Vessel Occlusion ◽  
Stroke Treatment ◽  
Before And After

BackgroundThe effectiveness of mechanical thrombectomy (MT) was demonstrated in five landmark trials published in2015.Mechanical thrombectomy is now standard of care for acute ischemic stroke and has been growing in popularity after publication of landmark trials.ObjectiveTo analyze outcomes and trends of the use of MT and intravenous thrombolysis (IVT) in patients with acute ischemic stroke in US hospitals before and after publication of these trials.MethodsPatients discharged with a diagnosis of ischemic stroke between 2012 to 2017 were diagnosed using ICD codes from the National Inpatient Sample. Thereafter, patients given acute stroke treatment were identified using the corresponding procedure codes for IVT and MT. The primary clinical outcomes of in-hospital mortality and disability were then compared between two time periods: 2012–2014 (pre-landmark trials) and 2015–2017 (post-landmark trials). Binary logistic regression and Χ2 tests were used for statistical analysis.ResultsA total of 57 675 patients (median age 68.9 years (range 18-90), 50.1% female) were identified with acute procedures. Of these patients, 57.6% were from the post-landmark trials time period. Despite an increased number of cases, the rate of IVT decreased from 84.3% to 75.9% and the rate of IVT+MT decreased from 7.1% to 6.3%. After publication of the pivotal trials in 2015, the rates of MT increased from 8.7% to 17.8%. Significant reductions of in-hospital mortality (7.1% vs 8.7%, p<0.001) and disability (64% vs 66.2%, p<0.001) were noted.ConclusionThe analysis showed a significant increase in the proportion of patients receiving MT after 2015. This has translated into reduction of in-hospital mortality and improvement in disability.

Association of High-sensitivity C-reactive Protein with Patient Prognosis Following Mechanical Thrombectomy for Acute Ischemic Stroke

2020 ◽  
Vol 17 (4) ◽  
pp. 402-410
Author(s):  
Seonggon Kim ◽  
Ho J. Yi ◽  
Dong H. Lee ◽  
Jae H. Sung
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Unfavorable Outcome ◽  
C Reactive Protein ◽  
Vessel Occlusion ◽  
Clinical Prognosis ◽  
Cutoff Value ◽  
Reactive Protein ◽  
Symptomatic Intracerebral Hemorrhage

Objective: The aim of this investigation was to examine the association of hsCRP (highsensitivity C-reactive protein) with outcomes and prognosis of patients who underwent mechanical thrombectomy (MT) for large vessel occlusion (LVO) after acute ischemic stroke (AIS). Methods: A total of 404 patients were enrolled, and outcomes included unfavorable clinical outcome at three months (modified Rankin Scale, mRS scores 3-6), the occurrence of symptomatic intracerebral hemorrhage (sICH) and hemorrhagic transformation (HT) of the infarct. Receiver operating characteristic (ROC) curve analysis was performed to identify the cutoff value of hsCRP to discriminate between favorable and unfavorable outcomes. The association of hsCRP with outcomes was evaluated using a logistic regression model. Results: The best cutoff value of hsCRP to distinguish between favorable and unfavorable outcomes at three months was identified as 3.0 mg/L (area under the curve, [AUC] 0.641, 95% confidence interval, [CI] 0.535-0.748; P = 0.014). In, multivariate analysis, patients with hsCRP ≥3 mg/L had more unfavorable outcome (odds ratio [OR] 1.72, 95% CI 1.42-2.02; P = 0.010), sICH (OR 2.64, 95% CI 1.62-3.66; P = 0.004), and HT of infarct (OR 1.72, 95% CI 1.42-2.02; P = 0.008) compared to those with hsCRP <1 mg/L. Conclusion: Our study demonstrates that patients with higher CRP levels had more unfavorable outcome, and exhibited higher sICH, and HT of infarct than those with lower CRP levels. Elevated hsCRP level, especially when higher than 3 mg/L, is an independent predictor for poor clinical prognosis in patients with MT for LVO.

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

2017 ◽  
Vol 7 (1-2) ◽  
pp. 12-18 ◽  
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.

Abstract P703: Association of Anemia With Functional Outcomes in Patients With Mechanical Thrombectomy

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Taha Nisar ◽  
Osama Abu-hadid ◽  
Toluwalase Tofade ◽  
Sara Shapouran ◽  
Muhammad Zeeshan Memon ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Functional Outcomes ◽  
Mechanical Thrombectomy ◽  
Infarct Volume ◽  
Retrospective Chart Review ◽  
World Health ◽  
Binary Logistic Regression Analysis ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Good Functional Outcome

Introduction: Anemia at presentation is associated with worse outcomes in patients with acute ischemic stroke. We aim to investigate the association of anemia upon presentation with functional outcomes in patients who undergo mechanical thrombectomy (MT). Methods: We performed a retrospective chart review of patients who underwent MT for anterior circulation large vessel occlusion at a comprehensive stroke center from 7/2014 to 5/2020. Anemia was considered a dichotomous categorical variable with a cutoff point of hemoglobin <12.0 g/dL in women and <13.0 g/dL in men, as per the definition of the World Health Organization. A binary logistic regression analysis was performed, controlling for age, pre-treatment-NIHSS, ASPECTS ≥6, TICI score ≥2b, onset to recanalization time, and administration of intravenous-alteplase (IV-rtPA), with the presence of anemia as the predictor. The primary outcome was a good functional outcome at 3-months (mRS of ≤1). The secondary outcomes were 3-month mortality, sICH (ECASS-II criteria), and infarct volume on follow-up CT Head. Results: 177 patients met our inclusion criteria. The mean age was 64.34±15.16 years. 93 (52.54%) patients were men. 34 (19.21%) patients had 3-month mRS≤1. 11 (6.21%) patients developed sICH. Among men, there was a significant association of anemia with lesser chance of good functional outcome (5.89% vs.23.73%; OR, 6.1; 95% CI, 1.3-30.5; P 0.028), higher mortality (52.94% vs.30.51%; OR, 2.9; 95% CI, 1.1-7.8; P 0.038), and a larger infarct volume (106.12±109.78mls vs.73.02±74.36mls.; OR, 1.1; 95% CI, 1.1-1.1; P 0.032), but not with sICH (5.89% vs.5.26%; OR, 1.6; 95% CI, 0.2-12.2; P 0.681). Among women, there was no significant association of anemia with any outcome measures: mRS ≤1 (25% vs.31.25%; OR, 0.84; 95% CI, 0.27-2.59; P 0.754), mortality (25% vs.23.08%; OR, 1.26; 95% CI, 0.4-3.97; P 0.693), infarct volume (60.08±94.46mls vs.69.05±97.74mls.; OR, 1; 95% CI, 1-1.01; P 0.981), and sICH (9.37% vs.5.89%; OR, 1.52; 95% CI, 0.26-8.88; P 0.643). Conclusions: Our study demonstrates a gender difference in outcomes in patients with anemia at presentation who undergo MT. In our cohort, men had an association between anemia and mRS≤1, mortality, and a larger infarct volume, unlike women.

Value of high-density sign on CT images after mechanical thrombectomy for large vessel occlusion in predicting hemorrhage and unfavorable outcome

2020 ◽  
pp. 197140092097525
Author(s):  
Eduardo Portela de Oliveira ◽  
Santanu Chakraborty ◽  
Mihilkumar Patel ◽  
Stefanos Finitsis ◽  
Daniela Iancu
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Hemorrhagic Transformation ◽  
Ct Images ◽  
High Density ◽  
Unfavorable Outcome ◽  
Post Intervention ◽  
Vessel Occlusion

Purpose Cerebral hyperdensities can appear on head computed tomography (CT) images performed early after endovascular treatment (EVT) in patients with acute ischemic stroke and may be secondary to contrast staining or hemorrhagic transformation. The aim of this study was to determine how the high-density sign on CT affects mortality and clinical outcome and whether CT parameters predict hemorrhagic conversion or unfavorable outcome. Methods We retrospectively reviewed a database of patients who underwent EVT with mechanical thrombectomy for acute ischemic stroke over 7 years. Included were acute stroke patients with a CT examination within 24 h post-EVT with mechanical thrombectomy, demonstrating areas of hyperdensity. We evaluated morphologic characteristics of these lesions, location, CT Hounsfield units and largest area, as well as patient demographics, EVT methods and patient outcome. Results A total of 29 patients met the strict inclusion criteria. Complete recanalization was achieved in 58.6% (17/29). Seventeen (58.6%) cases of post-intervention cerebral hyperdensities were related to contrast staining and 12 (41.4%) cases to contrast staining and hemorrhage. Patient mortality was significantly higher in the hemorrhagic group (50.0% versus 5.9%, p = 0.003). The increased density on CT was associated with higher hemorrhagic risk (odds ratio 1.05, p = 0.036). Conclusion Patients with the high-density sign on CT images after mechanical thrombectomy for acute ischemic stroke demonstrated increased mortality and worse clinical outcome, primarily when these hyperdensities were related to hemorrhage. CT imaging parameters as higher density areas can help in the differentiation of hemorrhage from contrast staining.

Abstract 1122‐000093: Association of Pre‐Mechanical Thrombectomy Collateral Scores with Functional‐Outcome in Short Versus Extended Window for Thrombectomy

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Taha Nisar ◽  
Osama Abu‐Hadid ◽  
Konrad Lebioda ◽  
Toluwalase Tofade ◽  
Priyank Khandelwal
Keyword(s):  
Functional Outcome ◽  
Mechanical Thrombectomy ◽  
Retrospective Chart Review ◽  
Binary Logistic Regression ◽  
Binary Logistic Regression Analysis ◽  
Inclusion Criteria ◽  
Anterior Circulation ◽  
Good Functional Outcome ◽  
Ct Angiogram ◽  
Comprehensive Stroke Center

Introduction : We aim to determine the utility of pre‐mechanical‐thrombectomy (MT) collateral scores in the short (<6 hours from onset) versus extended (6‐24 hours from onset) window for MT with respect to a good functional‐outcome. Methods : We performed a retrospective chart review of patients who underwent MT for anterior circulation LVO at a comprehensive stroke center from 7/2014 to 12/2020. A board‐certified neuroradiologist, who was blinded to the clinical‐outcomes, used collateral grading scales of Miteff (ordinal), Mass (ordinal), and modified‐Tan (dichotomous) to designate collateral scores on the pre‐MT CT Angiogram. The patients were divided into short (<6 hours from onset) versus extended (6‐24 hours from onset) groups depending on their timing of presentation to the emergency department. A binary logistic regression analysis was performed, controlling for age, sex, NIHSS, ASPECTS≥6, TICI score≥2b, recanalization time, mean arterial pressure, blood glucose, location of occlusion, atrial fibrillation, LDL, hemoglobin‐A1C, and administration of intravenous‐alteplase, with the pre‐MT collateral grading scores as predictors. The primary outcome was a good functional‐outcome (3‐month mRS≤2) Results : 162 patients met our inclusion criteria for patients who presented in the short window. The pre‐MT scales of Mass (OR, 0.35; 95%CI, 0.16‐0.78; P 0.01) and modified‐Tan (OR, 0.35; 95%CI, 0.16‐0.78; P 0.01) were associated with a good functional‐outcome, unlike the Miteff scale (OR, 0.46; 95% CI, 0.18‐1.18; P 0.103). 58 patients met our inclusion criteria for patients who presented in the extended window. The pre‐MT scales of Mass (OR, 0.75; 95% CI, 0.23‐2.48; P 0.63), Miteff scale (OR, 0.78; 95%CI, 0.17‐3.64; P 0.746) and modified‐Tan (OR, 1.14; 95%CI, 0.1‐12.98; P 0.918) were not associated with a good functional‐outcome. Conclusions : Our study demonstrates that good collateral grades on Mass and modified‐Tan scales are associated with a good functional outcome for patients who present to the ED in the short window for MT. We did not find an association of any pre‐MT collateral scores with a good functional‐outcome for patients presenting in the extended window for MT.

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