Predictors of Poor Outcome Despite Successful Mechanical Thrombectomy of Anterior Circulation Large Vessel Occlusions Within 6 h of Symptom Onset

• Authors: Mahmoud Mohammaden, Emory University; Christopher J. Stapleton, University of Illinois at Chicago; Denise Brunozzi, University of Illinois at Chicago; Ahmad E. Hussein, University of Illinois at Chicago; Eman M. Khedr, Assiut University; Gursant Atwal, University of Illinois at Chicago; Ali Alaraj, University of Illinois at Chicago
• Journal Title: Frontiers in Neurology
• Volume: Volume 11
• Publisher: Frontiers | 2020-09-04
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.3389/fneur.2020.00907
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: acute ischemic stroke; mechanical thrombectomy; internal carotid artery occlusion; distal clot migration; poor functional outcome

Abstract

Background and Purpose: Successful reperfusion is a significant predictor of a good clinical outcome after mechanical thrombectomy (MT). However, some patients have a poor clinical outcome even with successful reperfusion. We aimed to study factors that predict a poor clinical outcome (90-day modified Rankin Scale ≥ 3) in patients with anterior circulation large vessel occlusion (LVO) treated by successful MT within 6 h of symptom onset. Methods: We performed a retrospective review of a prospectively maintained MT database of all patients who underwent MT within 6 h of symptom onset for an anterior circulation LVO at our institution from May 2016 to June 2018. Uni- and multivariable analyses were performed to identify predictors of poor outcome. Results: A total of 56 patients met the criteria for inclusion in this study. A poor outcome occurred in 31 (55.4%) patients. On univariate analysis, compared to patients with good clinical outcome, patients with poor outcome had higher mean baseline NIHSS scores (23.3 vs. 13.8, P < 0.001), were more likely to have internal carotid artery (ICA) occlusions (38.7 vs. 8%, P = 0.008), and had a higher incidence of distal clot migration (DCM) (48.4 vs. 8%, P = 0.028). Age, gender, other baseline clinical characteristics, MT technique, and incidence of hemorrhagic transformation did not differ between the two cohorts. On multivariable regression analysis, baseline NIHSS score [OR; 1.3, 95%CI [1.11–1.52], P = 0.001], site of occlusion (ICA) [OR; 8.9, 95%CI [1.3–60.9], P = 0.026], and DCM [OR; 5.77, 95%CI [1.09–30.69], P = 0.04] were independent predictors of poor outcome at 90-days. Conclusion: Baseline NIHSS score, ICA occlusion, and DCM are independent predictors of a poor outcome after MT for anterior circulation LVO performed within 6 h of symptoms onset.