Predictors of poor outcome despite successful endovascular treatment for ischemic stroke: results from the MR CLEAN Registry

You blithering idiots, the stroke medical world has accepted these failures since the beginning of time and passed them of as success by bamboozling everyone into accepting their tyranny of low expectations.

Hope they are OK with that shitworthy result when they are the 1 in 4 per WHO that has a stroke?

 

 Predictors of poor outcome despite successful endovascular treatment for ischemic stroke: results from the MR CLEAN Registry

1. Rob A van de Graaf1,2,
2. Noor Samuels1,2,3,
3. Vicky Chalos1,2,3,
4. Geert J Lycklama a Nijeholt4,
5. Heleen van Beusekom5,
6. Albert J Yoo6,
7. http://orcid.org/0000-0003-1631-7056Wim H van Zwam7,
8. Charles B L M Majoie8,
9. Yvo B W E M Roos9,
10. Pieter Jan van Doormaal1,
11. Wagih Ben Hassen10,
12. Aad van der Lugt1,
13. http://orcid.org/0000-0002-9234-3515Diederik W J Dippel2,
14. Hester F Lingsma3,
15. Adriaan C G M van Es11,
16. Bob Roozenbeek1,2
17. MR CLEAN Registry investigators

1. Correspondence to Rob A van de Graaf, Radiology & Nuclear Medicine and Neurology, Erasmus Medical Center, 3015 GD Rotterdam, Zuid-Holland, The Netherlands; r.a.vandegraaf@erasmusmc.nl

Abstract

Background Approximately one-third of patients with ischemic stroke treated with endovascular treatment do not recover to functional independence despite rapid and successful(It wasn't successful if you didn't get to 100% recovery.) recanalization. We aimed to quantify the >/u> importance of predictors of poor functional outcome despite successful reperfusion.

Methods We analyzed patients from the MR CLEAN Registry between March 2014 and November 2017 with successful reperfusion (extended Thrombolysis In Cerebral Infarction ≥2B). First, predictors were selected based on expert opinion and were clustered according to acquisition over time (ie, baseline patient factors, imaging factors, treatment factors, and postprocedural factors). Second, several models were constructed to predict 90-day functional outcome (modified Rankin Scale (mRS)). The relative importance of individual predictors in the most extensive model was expressed by the proportion of unique added χ² to the model of that individual predictor.

Results Of 3180 patients, 1913 (60%) had successful reperfusion. Of these 1913 patients, 1046 (55%) were functionally dependent at 90 days (mRS >2). The most important predictors for mRS were baseline patient factors (ie, pre-stroke mRS, added χ² 0.16; National Institutes of Health Stroke Scale score at baseline, added χ² 0.12; age, added χ² 0.10), and postprocedural factors (ie, symptomatic intracranial hemorrhage (sICH), added χ² 0.12; pneumonia, added χ² 0.09). The probability of functional independence for a typical stroke patient with sICH was 54% (95% CI 36% to 72%) lower compared with no sICH, and 21% (95% CI 4% to 38%) for pneumonia compared with no pneumonia.

Conclusion Baseline patient factors and postprocedural adverse events are important predictors of poor functional outcome in successfully reperfused patients with ischemic stroke. This implies that prevention of postprocedural adverse events has the greatest potential to further improve outcomes in these patients.

Data availability statement

No data are available. Data cannot be made available, as no patient approval has been obtained for sharing coded data. However, R syntax and output files of the analyses will be made available on request.

http://dx.doi.org/10.1136/neurintsurg-2021-017726