Factors affecting mechanical thrombectomy outcome in acute ischemic stroke patients: an Egyptian sample

Abstract

Background Stroke constitutes a major health problem worldwide, nowadays endovascular treatment is considered to be a standard of care in acute ischemic stroke patients with large vessel occlusion, accurate prediction of outcome of thrombectomy is essential for health care providers, patients and families. We studied different clinical and radiological variables that could predict functional outcome in stroke patients after thrombectomy. Thirty-four consecutive ischemic stroke patients were included, received intravenous tissue plasminogen activator (iv-tpa), then mechanical thrombectomy was done. Patients were clinically assessed at admission with National Institute of Health Stroke Scale (NIHSS) then evaluated by the Alberta Stroke Program early computerized tomography (CT) score (ASPECTS), clot burden scale (CBS) and collateral score (CS) in multiphase computerized tomography angiography (CTA) then good and poor outcomes at 3 months were defined by Modified Rankin Scale (MRS) of 0–2 and 3–6 points, respectively. Results Factors associated with good outcome (MRS 0–2) were lower admission NIHSS score (p < 0.037), small infarct core aspects ≥ 6 (p < 0.001), low clot burden (CBS 7–10) (p = 0.046) good collaterals (2–3) (p = 0.038) and absence of post-procedure hemorrhage (p < 0.0005). Conclusions Low admission NIHSS score, absence of post-procedure hemorrhage, small infarct core, low clot burden and good collaterals are reliable factors for good clinical outcome.

Functional long-term outcome following endovascular thrombectomy in patients with acute ischemic stroke

“…In addition to comprehensiveness, an important difference of our analysis as compared to previously published studies is the prolonged follow-up interval after stroke. Most published studies evaluated clinical outcome using mRS at day 90 [ 3 , 10 , 12 , 26 , 28 , 31 – 33 , 37 , 38 , 46 , 47 , 50 – 52 ]. Only a few studies assessed the clinical outcome beyond 90 days after the index event [ 5 , 14 , 16 , 36 , 53 ].…”

“…In a study with nonagenarians (patients aged ≥ 90 years) who underwent EVT, 28.9% achieved a favourable clinical outcome after 90 days (mRS 0–2) [ 46 ]. Severity on admission measured by NIHSS is a relevant predictor of outcome in some analyses [ 3 , 10 , 12 , 26 , 33 , 52 , 53 ]. The NIHSS score at 24 h post intervention with a threshold of ≤ 8 has also been described as the best surrogate marker for long-term functional outcome after thrombectomy of the anterior circulation.…”

“…without multimodal imaging) urges the need for identifying predictors of complete recanalisation and good clinical outcome. The assessment of clinical outcome as well as outcome prediction usually are based on the mRS at day 90 [ 3 , 10 , 12 , 26 , 28 , 31 – 33 , 37 , 38 , 46 , 47 , 50 – 52 ], the standard outcome measure in AIS studies. Only a few studies have investigated factors influencing long-term outcome beyond day 90 [ 5 , 14 , 16 , 36 , 53 ].…”