You're still required to get them to 100% recovery! What are your EXACT BACKUP PLANS? Don't have any, then you don't have a functioning stroke doctor! Leaders plan for all eventualities, do you have leaders in your stroke hospital?
Predictors of Futile Recanalization in Ischemic Stroke Patients with low baseline NIHSS
Abstract
Background
There
is yet no randomized controlled evidence that mechanical thrombectomy
(MT) is superior to best medical treatment in patients with large vessel
occlusion but minor stroke symptoms (National Institutes of Health
Stroke Scale [NIHSS] <6). Prior studies of patients with admission
NIHSS scores >6 observed unfavorable functional outcomes despite
successful recanalization, commonly termed as futile recanalization
(FR), in up to 50% of cases.
Aim
The
aim of this study is to determine the prevalence of FR in patients with
minor stroke and identify associated patient-specific risk factors.
Methods
Our
multicenter cohort study screened all patients prospectively enrolled
in the German Stroke Registry Endovascular Treatment from 2015 to 2021
(n=13082). Included were patients who underwent MT for anterior
circulation vessel occlusion with a baseline NIHSS score of <6 and
successful recanalization (modified Thrombolysis in Cerebral Infarction
[mTICI] score of 2b–3). FR was defined by a modified Rankin Scale (mRS)
score of 2–6 at 90 days. Multivariable logistic regression analysis was
conducted to explore factors associated with FR.
Results
A
total of 674 patients met the inclusion criteria. FR occurred in 268
(40%) patients. Multivariable logistic regression analysis indicates
that higher age (adjusted odds ratio: 1.04 [95% confidence interval:
1.02-1.06]), pre-stroke mRS 1 (aOR: 2.70 [1.51-4.84]), transfer from
admission hospital to comprehensive stroke center (aOR: 1.67
[1.08-2.56]), longer time from symptom onset/last seen well to admission
(aOR: 1.02 [1.00-1.04]), MT under general anesthesia (aOR: 1.78
[1.13-2.82]), higher NIHSS after 24 hours (aOR: 1.09 [1.05-1.14]), and
symptomatic intracranial hemorrhage (aOR: 16.88 [2.03-140.14]) increased
the odds of FR. There was no significant difference in primary outcome
between achieving mTICI 2b or 3.
Conclusions
Unfavorable
functional outcomes despite successful vessel recanalization were
frequent in acute ischemic stroke patients with low NIHSS scores on
admission.(Well duh! Recanalization is only the first step in treating stroke. After that your doctor has to stop the
neuronal cascade of death, saving hundreds of million to billions of neurons! If your doctor isn't treating the neuronal cascade of death, you don't have a functioning stroke doctor!) We provide patient-specific risk factors that indicate an increased risk of FR and should be considered when treating patients with minor stroke.
Data access statement
The
data that support the findings of our study are available on reasonable
request after approval of the GSR steering committee.
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