Predictors of poor outcome despite successful endovascular treatment for ischemic stroke: results from the MR CLEAN Registry. (15th July 2021)

• Record Type: Journal Article
• Authors: van de Graaf, Rob A; Samuels, Noor; Chalos, Vicky; Lycklama a Nijeholt, Geert J; van Beusekom, Heleen; Yoo, Albert J; van Zwam, Wim H; Majoie, Charles B L M; Roos, Yvo B W E M; van Doormaal, Pieter Jan; Ben Hassen, Wagih; van der Lugt, Aad; Dippel, Diederik W J; Lingsma, Hester F; van Es, Adriaan C G M; Roozenbeek, Bob
• Other Names: author non-byline.; Oostenbrugge Robert J van author non-byline.; Boiten Jelis author non-byline.; Vos Jan Albert author non-byline.; Jansen Ivo GH author non-byline.; Mulder Maxim JHL author non-byline.; Goldhoorn Robert-Jan B author non-byline.; Compagne Kars CJ author non-byline.; Kappelhof Manon author non-byline.; Brouwer Josje author non-byline.; Hartog Sanne J den author non-byline.; Hinsenveld Wouter H author non-byline.; Emmer Bart J author non-byline.; Coutinho Jonathan M author non-byline.; Schonewille Wouter J author non-byline.; Wermer Marieke JH author non-byline.; Walderveen Marianne AA van author non-byline.; Staals Julie author non-byline.; Hofmeijer Jeannette author non-byline.; Martens Jasper M author non-byline.; Bruijn Sebastiaan F de author non-byline.; Dijk Lukas C van author non-byline.; Bart van der Worp H author non-byline.; Lo Rob H author non-byline.; Dijk Ewoud J van author non-byline.; Boogaarts Hieronymus D author non-byline.; de Vries J author non-byline.; Kort Paul LM de author non-byline.; Tuijl Julia van author non-byline.; Peluso Jo P author non-byline.; Fransen Puck author non-byline.; Berg Jan SP van den author non-byline.; Hasselt Boudewijn AAM van author non-byline.; Aerden Leo AM author non-byline.; Dallinga René J author non-byline.; Uyttenboogaart Maarten author non-byline.; Eschgi Omid author non-byline.; Bokkers Reinoud PH author non-byline.; Schreuder Tobien HCML author non-byline.; Heijboer Roel JJ author non-byline.; Keizer Koos author non-byline.; Yo Lonneke SF author non-byline.; Hertog Heleen M den author non-byline.; Sturm Emiel JC author non-byline.; Brouwers Paul JAM author non-byline.; Sprengers Marieke ES author non-byline.; Jenniskens Sjoerd FM author non-byline.; Berg René van den author non-byline.; Beenen Ludo FM author non-byline.; Postma Alida A author non-byline.; Roosendaal Stefan D author non-byline.; Kallen Bas FW van der author non-byline.; Wijngaard Ido R van den author non-byline.; Bot Joost author non-byline.; Meijer Anton author non-byline.; Ghariq Elyas author non-byline.; Proosdij Marc P van author non-byline.; Menno Krietemeijer G author non-byline.; Lo Rob author non-byline.; Gerrits Dick author non-byline.; Dinkelaar Wouter author non-byline.; Appelman Auke PA author non-byline.; Hammer Bas author non-byline.; Pegge Sjoert author non-byline.; Hoorn Anouk van der author non-byline.; Vinke Saman author non-byline.; Zwenneke Flach H author non-byline.; Ghannouti Naziha el author non-byline.; Sterrenberg Martin author non-byline.; Puppels Corina author non-byline.; Pellikaan Wilma author non-byline.; Sprengers Rita author non-byline.; Elfrink Marjan author non-byline.; Simons Michelle author non-byline.; Vossers Marjolein author non-byline.; Meris Joke de author non-byline.; Vermeulen Tamara author non-byline.; Geerlings Annet author non-byline.; Vemde Gina van author non-byline.; Simons Tiny author non-byline.; Rijswijk Cathelijn van author non-byline.; Messchendorp Gert author non-byline.; Nicolaij Nynke author non-byline.; Bongenaar Hester author non-byline.; Bodde Karin author non-byline.; Kleijn Sandra author non-byline.; Lodico Jasmijn author non-byline.; Droste Hanneke author non-byline.; Wollaert Maureen author non-byline.; Verheesen Sabrina author non-byline.; Jeurrissen D author non-byline.; Bos Erna author non-byline.; Drabbe Yvonne author non-byline.; Sandiman Michelle author non-byline.; Aaldering Nicoline author non-byline.; Zweedijk Berber author non-byline.; Khalilzada Mostafa author non-byline.; Vervoort Jocova author non-byline.; Ponjee Eva author non-byline.; Romviel Sharon author non-byline.; Kanselaar Karin author non-byline.; Barning Denn author non-byline.; Venema Esmee author non-byline.; Geuskens Ralph R author non-byline.; Straaten Tim van author non-byline.; Ergezen Saliha author non-byline.; Harmsma Roger RM author non-byline.; Muijres Daan author non-byline.; Jong Anouk de author non-byline.; Berkhemer Olvert A author non-byline.; Boers Anna MM author non-byline.; Huguet J author non-byline.; Groot PFC author non-byline.; Mens Marieke A author non-byline.; Kranendonk Katinka R van author non-byline.; Treurniet Kilian M author non-byline.; Tolhuisen Manon L author non-byline.; Alves Heitor author non-byline.; Weterings Annick J author non-byline.; Kirkels Eleonora LF author non-byline.; Voogd Eva JHF author non-byline.; Schupp Lieve M author non-byline.; Collette Sabine author non-byline.; Groot Adrien ED author non-byline.; LeCouffe Natalie E author non-byline.; Konduri Praneeta R author non-byline.; Prasetya Haryadi author non-byline.; Arrarte-Terreros Nerea author non-byline.; Ramos Lucas A author non-byline.;
• Is Part Of: Journal of neurointerventional surgery. Volume 14:Number 7(2022)
• Page Start: 660
• Page End: 665
• Publication Date: 2021-07-15
• Subjects: stroke -- thrombectomy -- intervention; Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2021-017726
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Background: Approximately one-third of patients with ischemic stroke treated with endovascular treatment do not recover to functional independence despite rapid and successful recanalization. We aimed to quantify the 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 χ 2 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 χ 2 0.16; National Institutes of Health Stroke Scale score at baseline, added χ 2 0.12; age, added χ 2 0.10), and postprocedural factors (ie, symptomatic intracranial hemorrhage (sICH), added χ 2 0.12; pneumonia, added χ 2 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.