Abstract
Background and Purpose—
The
clinical course in patients with ischemic stroke treated with
mechanical thrombectomy (MT) is heterogeneous. We aimed to study the
relevance of the timing of clinical improvement in the prediction of
long-term outcome in patients treated with MT.
Methods—
We
studied a cohort of 423 patients with anterior circulation stroke
treated with MT, of whom 334 patients (79.0%) achieved good outcome
(modified Rankin Scale score of 0–2 at 90-day follow-up). National
Institutes of Health Stroke Scale scores were assessed before MT, at the
end of MT (d0), at day 1 (d1), and at day 7 or discharge (d7). We
explored the predictive value for good outcome of different cutoffs
based on absolute and percentage changes in the National Institutes of
Health Stroke Scale at each assessment (d0, d1, and d7) and selected the
corresponding most informative cutoffs to define substantial clinical
improvement (SCI) over time. Then, we classified patients in SCI
subgroups according to the delay from MT to SCI (SCI-d0, SCI-d1, and
SCI-d7) and analyzed their adjusted odds ratio for good outcome compared
with patients not presenting SCI (no-SCI). Additionally, we identified
the independent factors predicting SCI-d0 in multivariate models.
Results—
The
most informative cutoffs were 30% at d0, 40% at d1, and 70% at d7. The
adjusted odds ratios (95% CI) for good outcome were 47.4 (22.1–101.7,
n=172) for SCI-d0, 27.7 (11.8–65.0, n=76) for SCI-d1, and 12.6 for
SCI-d7 (95% CI, 3.8–41.4, n=17) compared with no-SCI (n=158). The
independent factors predicting SCI-d0 were successful reperfusion (odds
ratio, 25.79; 95% CI, 12.92–51.47) and shorter time to treatment (odds
ratio per hour 0.90; 95% CI, 0.85–0.96).
Conclusions—
Shorter
delay to clinical improvement is strongly related to better chances of a
long-term good outcome, and an improvement >30% in National
Institutes of Health Stroke Scale score at the end of MT represents a
reliable prognostic marker for clinicians and also for clinical
research.
Footnotes
Presented in part at the European Stroke Organisation Conference, Milan, Italy, May 22–24, 2019.
Guest Editor for this article was Seemant Chaturvedi, MD.
The online-only Data Supplement is available with this article at
https://www.ahajournals.org/doi/suppl/10.1161/STROKEAHA.118.024067.
Correspondence
to Ángel Chamorro, MD, PhD, Hospital Clinic, Comprehensive Stroke
Center, 170 Villarroel, Barcelona 08036, Spain, Email
achamorro@clinic.cat
Xabier Urra, MD, PhD, Hospital Clinic, Comprehensive Stroke Center, 170 Villarroel, Barcelona 08036, Spain, Email
xurra@clinic.cat
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