Factors Associated with 90-Day Outcomes of Patients with Acute Posterior Circulation Stroke Treated By Mechanical Thrombectomy

Luo, Gang; Mo, Dapeng; Tong, Xu; Liebeskind, David S; Song, Ligang; Ma, Ning; Gao, Feng; Sun, Xuan; Zhang, Xuelei; Wang, Bo; Jia, Baixue; Fernandez-Escobar, Alejandro; Miao, Zhongrong

doi:10.1016/j.wneu.2017.09.171

Cited by 63 publications

(51 citation statements)

References 45 publications

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“…The NIHSS scores were significantly more associated with insomnia, while these were not associated with mortality at 6-year follow-up. This result was consistent with another study by Luo et al 24, which exhibited that high NIHSS scores before treatment were associated with mortality at 90 days.…”

Section: Discussionsupporting

confidence: 93%

Insomnia is associated with increased mortality in patients with first-ever stroke: a 6-year follow-up in a Chinese cohort study

Yang

Guan

et al. 2018

Stroke Vasc Neurol

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ObjectiveInsomnia is a highly prevalent disorder among patients suffering from stroke. The association between insomnia and stroke mortality is less studied, particularly using the latest diagnostic criteria. The current study examined the relationship between insomnia and mortality among patients with first-evonal hazard models were used to calculate HRs for stroke er stroke in China.MethodsPatients with acute cerebrovascular diseases (stroke) were recruited from 56 hospitals in mainland China. Insomnia was defined as difficulty falling asleep, or difficulty staying asleep or waking up early, for at least two consecutive visits. Demographic data, medical history and clinical data were collected. Four follow-up visits occurred within the first year after stroke, and the last follow-up call was conducted 6 years later. Cox proportional hazard models were used to calculate HRs for stroke mortality.ResultsInsomnia was reported by 38.4% (489/1273) of patients at baseline. During the 6 years of follow-up, after adjusting for all confounders, insomnia was found to be associated with increased mortality (HR=1.66, 95% CI 1.10 to 2.48). Old age (HR=1.08, 95% CI 1.06 to 1.10), stroke recurrence in the first year of follow-up (HR=2.53, 95% CI 1.48 to 4.31) and stroke survivors with hypertension (HR=1.62, 95% CI 1.04 to 2.53) had substantially higher risk of mortality.ConclusionsBesides old age, stroke recurrence in the first year of follow-up and hypertension, insomnia is associated with increased risk of mortality in patients with first-ever stroke in China. More studies about prompt and efficient interventions for insomnia are expected in the future.Trial registration number rctn62169508.

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Section: Discussionsupporting

confidence: 93%

Insomnia is associated with increased mortality in patients with first-ever stroke: a 6-year follow-up in a Chinese cohort study

Yang

Guan

et al. 2018

Stroke Vasc Neurol

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“…We dichotomized ages above and below 75 years based on the criteria for advanced age used by the Japanese health insurance system. Because the threshold of 6 of both anterior circulation ASPECTS and pc‐ASPECT were reported to show good discrimination ability, we dichotomized both scores at 6 and combined both scores into a single risk factor. The threshold of 16 for NIHSS was determined by the median value of 15 of previous registry data .…”

Section: Methodsmentioning

confidence: 99%

Endovascular Therapy in Ischemic Stroke With Acute Large‐Vessel Occlusion: Recovery by Endovascular Salvage for Cerebral Ultra‐Acute Embolism Japan Registry 2

Yoshimura

Sakai

Uchida

et al. 2018

JAHA

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BackgroundEndovascular therapy has been shown to be effective in patients with acute cerebral large‐vessel occlusion, but real‐world efficacies are unknown.Methods and ResultsWe conducted a prospective registry at 46 centers between October 2014 and January 2017. Eligible patients were those who were aged 20 years or older, with acute cerebral large‐vessel occlusion, and who were hospitalized within 24 hours of the onset. We enrolled both consecutive patients who were treated with or without endovascular therapy. Endovascular therapy included thrombectomy, balloon angioplasty, stenting, local fibrinolysis, and piercing. The primary outcome was a favorable outcome as defined by a modified Rankin Scale of 0 to 2 at 90 days after onset. Secondary outcomes were modified Rankin Scale of 0 to 1 and mortality. Safety outcomes were intracerebral hemorrhage or a recurrence of ischemic stroke. We constructed the 2242 (1121 each) propensity score–matched patients cohort based on a propensity score for endovascular therapy and estimated the adjusted odds ratio, followed by sensitivity analyses on original 2399 (1278 in endovascular therapy versus 1121 in no endovascular therapy) patients. In the propensity score–matched cohort, favorable outcomes were observed in 35.3% and 30.7% of patients in the endovascular therapy and no endovascular therapy groups, respectively (P=0.02). The adjusted odds ratio for the favorable outcome was 1.44 (95% confidence interval, 1.10–1.86, P=0.007). The efficacy of endovascular therapy in achieving favorable outcomes did not differ between our subgroups and in the sensitivity analyses.ConclusionsEndovascular therapy decreased disabilities at 90 days in real‐world patients with acute cerebral large‐vessel occlusion.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT02419794.

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“…Neurological assessments were performed by evaluating the NIHSS and mRS scores at admission and during the follow-up examination (3 months after surgery). The 3-month mRS score was used to assess patient outcome; a score of 0–2 was considered as a favorable outcome and a score of 3–6 was considered to indicate a poor outcome (16,17).…”

Section: Methodsmentioning

confidence: 99%

Outcome prediction for patients with anterior circulation acute ischemic stroke following endovascular treatment: A single‑center study

Liu

Zhou

et al. 2019

Exp Ther Med

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Previous studies have identified various factors associated with the outcomes of acute ischemic stroke (AIS) but considered only 1 or 2 predictive factors. The present study aimed to use outcome-related factors derived from biochemical, imaging and clinical data to establish a logistic regression model that can predict the outcome of patients with AIS following endovascular treatment (EVT). The data of 118 patients with anterior circulation AIS (ACAIS) who underwent EVT between October 2014 and August 2018 were retrospectively analyzed. The patients were divided into 2 groups based on the modified Rankin Scale score at three months after surgery, where 0–2 points were considered to indicate a favorable outcome and 3–6 points were considered a poor outcome. Non-conditional logistic stepwise regression was used to identify independent variables that were significantly associated with patient outcome, which were subsequently used to establish a predictive statistical model, receiver operating characteristic (ROC) curve was used to show the performance of statistical model and analyze the specific association between each factor and outcome. Among the 118 patients, 47 (39.83%) exhibited a good and 71 (60.17%) exhibited a poor outcome. Multivariate analysis revealed that the predictive model was statistically significant (χ2=78.92; P<0.001), and that the predictive accuracy of the model was 83.1%, which was higher compared with that obtained using only a single factor. ROC curve analysis shows the area under curve of the statistical model was 0.823, the analysis of diagnostic threshold for prognostic factors indicated that age, diffusion-weighted imaging lesion volume, glucose on admission, National Institutes of Health Stroke Scale score on admission and hypersensitive C-reactive protein were valuable predictive factors for the outcome of EVT (P<0.05). In conclusion, a predictive model based on non-conditional logistic stepwise regression analysis was able to predict the outcome of EVT for patients with ACAIS.

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Factors Associated with 90-Day Outcomes of Patients with Acute Posterior Circulation Stroke Treated By Mechanical Thrombectomy

Cited by 63 publications

References 45 publications

Insomnia is associated with increased mortality in patients with first-ever stroke: a 6-year follow-up in a Chinese cohort study

Insomnia is associated with increased mortality in patients with first-ever stroke: a 6-year follow-up in a Chinese cohort study

Endovascular Therapy in Ischemic Stroke With Acute Large‐Vessel Occlusion: Recovery by Endovascular Salvage for Cerebral Ultra‐Acute Embolism Japan Registry 2

Outcome prediction for patients with anterior circulation acute ischemic stroke following endovascular treatment: A single‑center study

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