Deans' stroke musings: Predictors of futile recanalization in patients with acute ischemic stroke undergoing mechanical thrombectomy in late time windows

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, September 22, 2022

Predictors of futile recanalization in patients with acute ischemic stroke undergoing mechanical thrombectomy in late time windows

After you have predicted this failure what are your next steps to get your patients 100% recovered? Oh, you don't have any?

Predictors of futile recanalization in patients with acute ischemic stroke undergoing mechanical thrombectomy in late time windows

Heng Ni^†,

Xinglong Liu^†,

Yu Hang,

Zhenyu Jia,

Yuezhou Cao,

Haibin Shi,

Sheng Liu^* and

Linbo Zhao^*

Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

Background and purpose: Futile recanalization (FR), defined as functional dependence despite successful reperfusion, is common in patients who experience an acute stroke after thrombectomy. We aimed to determine the predictors of FR in patients who underwent thrombectomy in late time windows (6 h or more after symptom onset).

Methods: This retrospective review included patients who underwent thrombectomy for acute anterior circulation large vessel occlusion from October 2019 to June 2021. Successful reperfusion was defined as a modified Thrombolysis in Cerebral Infarction (mTICI) score of 2b/3. Functional dependence at 90 days was defined as a modified Rankin scale score of 3–6. Multivariate analysis and a receiver operating characteristic (ROC) curve were used to identify the predictors of FR in patients treated in delayed time windows.

Results: Of the 99 patients included, FR was observed in 51 (51.5%). In the multivariate analysis, older age (OR, 1.12; 95% CI, 1.04–1.22; P = 0.005), female sex (OR, 3.79; 95% CI, 1.08–13.40; P = 0.038), a higher National Institutes of Health Stroke Score (NIHSS) score upon admission (OR, 1.11; 95% CI, 1.02–1.22; P = 0.023), and an increased number of passes per procedure (OR, 2.07; 95% CI, 1.11–3.86; P = 0.023) were independently associated with FR after thrombectomy. The ROC curve indicated that the model that combined age, female sex, baseline NIHSS score, and the number of passes per procedure (area under the curve, 0.84; 95% CI, 0.75–0.90, P < 0.001) was able to predict FR accurately.

Conclusions: Older age, female sex, higher NIHSS score upon admission, and an increased number of passes per procedure were independent predictors of FR in patients who experienced acute ischemic strokes after thrombectomy in late time windows.

Introduction

Mechanical thrombectomy (MT) is widely accepted as a standard approach for acute large-vessel occlusions (LVOs) in the anterior circulation in patients with acute ischemic stroke (AIS) (1). Recently, the results from the DAWN and the DEFUSE-3 trials have demonstrated the safety and efficacy of MT in late time windows in patients with AIS selected by perfusion imaging (2, 3). However, a substantial proportion of patients experience futile recanalization (FR; defined as poor clinical outcomes despite successful recanalization) after thrombectomy in late time windows, even though these patients are screened with rigorous imaging (2–4). A real-world study showed that patients who underwent endovascular treatment more than 6 h after symptom onset had a relatively higher rate of poor outcomes despite successful reperfusion compared with those treated within 6 h of symptom onset (4). Thus, predicting FR in these specific populations could help select a population of patients treated with MT that would potentially benefit more of adjunctive therapies to maximize the benefit of MT.

Many previous studies have identified predictors of FR after endovascular treatment in early time windows in patients with AIS (5–12). However, few studies have investigated the predictors of FR in patients treated with MT in late time windows. Therefore, this study aimed to identify the potential predictors of FR in patients with AIS who underwent thrombectomy in late time windows.