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Predictors of Good Outcomes in Patients with Failed Endovascular Thrombectomy

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Author(s)
Hyungjong Park Byung Moon Kim Jang Hyun BaekJun Hwee Kim Ji Hoe Heo Dong Joon Kim Hyo Suk NamYoung Dae Kim
Keimyung Author(s)
Park, Hyung Jong
Department
Dept. of Neurology (신경과학)
Journal Title
Korean journal of radiology
Issued Date
2020
Volume
21
Issue
5
Keyword
Cerebral infarctionThrombectomyPrognosisPredictive factor
Abstract
Objective:
Endovascular thrombectomy (EVT) fails in approximately 20% of anterior circulation large vessel occlusion (AC-LVO). Nonetheless, the factors that affect clinical outcomes of non-recanalized AC-LVO despite EVT are less studied. The purpose of this study was to identify the factors affecting clinical outcomes in non-recanalized AC-LVO patients despite EVT.

Materials and methods:
This was a retrospective analysis of clinical and imaging data from 136 consecutive patients who demonstrated recanalization failure (modified thrombolysis in cerebral ischemia [mTICI], 0-2a) despite EVT for AC-LVO. Data were collected in prospectively maintained registries at 16 stroke centers. Collateral status was categorized into good or poor based on the CT angiogram, and the mTICI was categorized as 0-1 or 2a on the final angiogram. Patients with good (modified Rankin Scale [mRS], 0-2) and poor outcomes (mRS, 3-6) were compared in multivariate analysis to evaluate the factors associated with a good outcome.

Results:
Thirty-five patients (25.7%) had good outcomes. The good outcome group was younger (odds ratio [OR], 0.962; 95% confidence interval [CI], 0.932-0.992; p = 0.015), had a lower incidence of hypertension (OR, 0.380; 95% CI, 0.173-0.839; p = 0.017) and distal internal carotid artery involvement (OR, 0.149; 95% CI, 0.043-0.520; p = 0.003), lower initial National Institute of Health Stroke Scale (NIHSS) (OR, 0.789; 95% CI, 0.713-0.873; p < 0.001) and good collateral status (OR, 13.818; 95% CI, 3.971-48.090; p < 0.001). In multivariate analysis, the initial NIHSS (OR, 0.760; 95% CI, 0.638-0.905; p = 0.002), good collateral status (OR, 14.130; 95% CI, 2.264-88.212; p = 0.005) and mTICI 2a recanalization (OR, 5.636; 95% CI, 1.216-26.119; p = 0.027) remained as independent factors with good outcome in non-recanalized patients.

Conclusion:
Baseline NIHSS score, good collateral status, and mTICI 2a recanalization remained independently associated with clinical outcome in non-recanalized patients. mTICI 2a recanalization would benefit patients with good collaterals in non-recanalized AC-LVO patients despite EVT.
Keimyung Author(s)(Kor)
박형종
Publisher
School of Medicine (의과대학)
Citation
Hyungjong Park et al. (2020). Predictors of Good Outcomes in Patients with Failed Endovascular Thrombectomy. Korean journal of radiology, 21(5), 582–587. doi: 10.3348/kjr.2019.0578
Type
Article
ISSN
2005-8330
Source
https://www.kjronline.org/DOIx.php?id=10.3348/kjr.2019.0578
DOI
10.3348/kjr.2019.0578
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/43229
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Neurology (신경과학)
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