Factors Associated with 90-Day Outcomes of Patients with Acute Posterior Circulation Stroke Treated By Mechnical Thrombectomy

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Factors Associated with 90-Day Outcomes of Patients with Acute Posterior Circulation Stroke Treated By Mechnical Thrombectomy

Luo G, Mo D, Tong X, Liebeskind D, Song L, Ma N, Gao F, Sun X, Zhang X, Wang B, Jia B, Fernandez-Escobar A, Miao Z; World Neurosurgery (Oct 2017)

Tags:

• Interventional Radiology
• Stroke

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BACKGROUND AND PURPOSE Early recanalization of acute posterior circulation stroke due to large intracranial vessel occlusion by mechanical thrombectomy with stent retrievers may improve the outcome of patients. However, evidence of patient selection is still lacking. The study investigated the prognostic factors of acute posterior circulation stroke due to large intracranial arterial occlusion when treated with stent retriever thrombectomy.
METHODS A total of 69 patients from March 2012 to November 2016 were included in the study. These patients presented with acute posterior circulation stroke due to large intracranial vessel occlusion and underwent mechanical thrombectomy with Solitaire AB or combined with additional balloon and/or stenting angioplasty. Baseline characteristics, clinical course and imaging data of the patients were analyzed. Good clinical outcome (defined as a modified Rankin Scale score of 0 to 2 at 90 days) and safety outcome (defined as death within 90 days post-thrombectomy) were considered as endpoints. The association between factors with good clinical outcome and safety outcome was evaluated with both logistic regression and ROC (receiver operating characteristic curve) analyses.
RESULTS Of the 69 patients, mean(SD) age was 59(8) years and men comprised 82.6%(57/69). The median onset-to-treatment time was 360 (IQR = 250-537) minutes. The median National Institutes of Health Stroke Scale score (NIHSS) was 25 (IQR = 17-30) on admission. Successful recanalization was achieved in 62 of the 69 cases (89.9%) and 36.2% (25/69) were independent at 90 days. Regression analysis revealed that stroke subtype (intracranial atherosclerotic disease(ICAD) versus Embolism; odds ratio [OR], 0.101; 95% confidence interval [CI]0.020-0.501; p=0.005), baseline NIHSS score (≥22 versus<22; OR, 0.157; 95% CI 0.040-0.614; p=0.008) and pc-ASPECTS (posterior circulation Acute Stroke CT Score)on DWI (weighted magnetic resonance imaging)prethrombectomy(≥6 versus<6; OR, 7.335; 95% CI 1.495-36.191; p=0.014) were independent predictive factors of good clinical outcome, respectively at 90 days. Whereas high NIHSS (≥30 versus<30; OR, 5.569; 95% CI 1.573-19.716; p=0.008)and collateral status (≥2 versus<2; OR, 0.210; 95% CI 0.059-0.752; p=0.016) pretreatment was associated with mortality at 90 days. Base on ROC curves, baseline NIHSS score (area under the curve [AUC] = 0.779; cut off:≥22; p<0.001; sensitivity 72% and specificity 77.3%), pc-ASPECT on DWI (AUC = 0.820; cut off: ≥6; p<0.001; 72% and specificity 77.3%) pretreatment were independent indicators predicting good clinical outcome at 90 days. Elevated risk of death by 90 days was associated with baseline NIHSS score (AUC = 0.719; cut off: ≥30; p=0.007; sensitivity 64.7% and specificity 78.9%) and worse collateral status (AUC = 0.820; cut off: ≥2; p<0.001; sensitivity 58.8% and specificity 80.8%) pretreatment.
CONCLUSION Stroke subtype, initial stroke severity, pc-ASPECTS on DWI as well as collateral status prethrombectomy are independent factors affecting the clinical outcome in patients treated with Solitaire AB thrombectomy for acute posterior circulation stroke due to large intracranial vessel occlusion.