Predictors of Poor Outcome Despite Successful Mechanical Thrombectomy of Anterior Circulation Large Vessel Occlusions Within 6 h of Symptom Onset

You blithering idiots, we don't need you predicting poor outcomes, we need you to prevent and solve the problem. Do you think any survivor cares about your fucking prediction of poor recovery?  I would be screaming my bloody head off if a doctor said such crapola to me, you should do the same. Doctors need to hear the truth about their incompetence.

Predictors of Poor Outcome Despite Successful Mechanical Thrombectomy of Anterior Circulation Large Vessel Occlusions Within 6 h of Symptom Onset

Mahmoud H. Mohammaden^1,2, Christopher J. Stapleton³, Denise Brunozzi³, Ahmad E. Hussein³, Eman M. Khedr⁴, Gursant Atwal³ and Ali Alaraj^3*

• ¹Department of Neurology, South Valley University Qena Faculty of Medicine, Qena, Egypt
• ²Department of Neurology, Marcus Stroke and Neuroscience Center, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA, United States
• ³Department of Neurosurgery, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
• ⁴Department of Neurology, Faculty of Medicine, Assiut University, Assiut, Egypt

Background and Purpose: Successful reperfusion is a significant predictor of a good clinical outcome after mechanical thrombectomy (MT). However, some patients have a poor clinical outcome even with successful reperfusion. We aimed to study factors that predict a poor clinical outcome (90-day modified Rankin Scale ≥ 3) in patients with anterior circulation large vessel occlusion (LVO) treated by successful MT within 6 h of symptom onset.

Methods: We performed a retrospective review of a prospectively maintained MT database of all patients who underwent MT within 6 h of symptom onset for an anterior circulation LVO at our institution from May 2016 to June 2018. Uni- and multivariable analyses were performed to identify predictors of poor outcome.

Results: A total of 56 patients met the criteria for inclusion in this study. A poor outcome occurred in 31 (55.4%) patients. On univariate analysis, compared to patients with good clinical outcome, patients with poor outcome had higher mean baseline NIHSS scores (23.3 vs. 13.8, P < 0.001), were more likely to have internal carotid artery (ICA) occlusions (38.7 vs. 8%, P = 0.008), and had a higher incidence of distal clot migration (DCM) (48.4 vs. 8%, P = 0.028). Age, gender, other baseline clinical characteristics, MT technique, and incidence of hemorrhagic transformation did not differ between the two cohorts. On multivariable regression analysis, baseline NIHSS score [OR; 1.3, 95%CI [1.11–1.52], P = 0.001], site of occlusion (ICA) [OR; 8.9, 95%CI [1.3–60.9], P = 0.026], and DCM [OR; 5.77, 95%CI [1.09–30.69], P = 0.04] were independent predictors of poor outcome at 90-days.

Conclusion: Baseline NIHSS score, ICA occlusion, and DCM are independent predictors of a poor outcome after MT for anterior circulation LVO performed within 6 h of symptoms onset.

Introduction

Stroke is the third leading cause of death in developed countries and the most common cause of permanent disability (1). Mechanical thrombectomy (MT) within 6 h of symptom onset is the standard treatment for acute ischemic stroke (AIS) due to anterior circulation emergent large vessel occlusion (ELVO) (2). The guidelines extended the eligibility of MT after the results of the Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke (DEFUSE 3) (3) and the DWI or CTP Assessment with Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention with Trevo (DAWN) (4) trials up to 16 and 24 h, respectively in well-selected patients with clinical/imaging mismatch (2).

The outcome after MT depends mainly on the degree of recanalization, with the failure of recanalization is the strongest predictor of poor outcome (5). Despite the use of modern era devices and techniques for MT, which has enhanced the speediness and completeness of reperfusion of the downstream territory, the likelihood of a good functional outcome (modified Rankin Scale, mRS0-2) at 90 days was 46% with many procedures are futile (6).

In this study, we aimed to evaluate the predictors of poor functional outcome at 90-days in patients with successful recanalization within 6 h of symptom onset.(Survivors don't want predictions of poor outcome, they want solutions that prevent that poor outcome. REALLY, you are that fucking stupid if you never thought of what survivors want. The recanalization was not successful if a poor outcome results.)