Prognostic factors for acute posterior circulation cerebral infarction patients after endovascular mechanical thrombectomy

Abstract

This article was to analyze the factors influencing the prognosis of posterior circulation cerebral infarction (PCCI) patients, retrospectively. One hundred forty five patients diagnosed with PCCI in Nanyang Central Hospital between June 25, 2016 and October 14, 2019 were included and underwent cerebral vascular mechanical thrombectomy. The clinical data of those patients were collected. The patients were followed up for 3 months to observe the prognostic efficacy and explore the influencing factors for poor prognosis. The potential prognostic factors for PCCI patients after emergency endovascular mechanical thrombectomy were analyzed by univariate and multivariable logistic regression. The thermodynamic diagram was drawn to explore the associations between the prognostic factors. The risk of poor prognosis in PCCI patients receiving emergency endovascular mechanical thrombectomy was reduced by 0.552 time with every 1-point increase of the Alberta Stroke Program Early CT in posterior circulation score (odds ratio [OR] = 0.448, 95% confidence interval [CI]: 0.276–0.727). The risk of poor prognosis was increased by 0.827 time for each additional grade in the digital subtraction angiography-American Society of Intervention and Therapeutic Neuroradiology grading (OR = 1.827, 95% CI: 1.221–2.733, P = .003) and increased by 0.288 time for every 1-point increase in National Institutes of Health Stroke scale at 24 hours (OR = 1.288, 95% CI: 1.161–1.429). All P < .05. Alberta Stroke Program Early CT in posterior circulation score, digital subtraction angiography-American Society of Intervention and Therapeutic Neuroradiology grading, National Institutes of Health Stroke scale score at 24 hours were factors affecting the prognosis of PCCI patients undergoing emergency endovascular mechanical thrombectomy, which might provide evidence for endovascular treatment of PCCI.

Efficacy and safety of mechanical thrombectomy in the posterior cerebral circulation—a single center study

“…These results are consistent with reports from previous studies 10 , 15 , 20 – 24 , 29 , 30 and imply the conclusion, that the milder the stroke is, the better outcomes could be achieved. Moreover, both the literature reports and our results concur that a higher NIHSS score is associated with a less favorable prognosis particularly in PMT, for both short-term (OR: 0.865, 95% CI: 0.840–0.890) and long-term (OR: 0.900, 95% CI: 0.879–0.921) outcomes 25 – 27 , 31 . Furthermore, Kniep et al 26 showed that the 24-h NIHSS score ≤ 9 best serves as a surrogate for a favorable outcome (0–2 mRS) on the 90th day after PMT (AUC: 0.89, 95% Cl: 0.85–0.92).…”

“…Numerous studies have consistently demonstrated that older patients have a reduced likelihood of achieving a good functional status and experience higher mortality rates compared to their younger counterparts 19 – 24 . This effect was also pronounced purely in patients after PMT, both in our results (OR: 0.978, 95% CI: 0.966–0.990, for favorable outcomes on the 90th day) and in those of other authors 25 – 27 . On the other hand, influence of age on the outcomes of MT is not necessarily clear; Sweid et al performed a study comparing outcomes in the individuals over and under 90 years of age and found no significant differences between the groups, even reporting a lower mortality rate in the elderly group (11.54% vs. 13.06%, p = 0.82) 28 .…”

Nomogram to predict prognosis in patients with posterior circulation acute ischemic stroke after mechanical thrombectomy

“…A meta-analysis revealed that hypertension and diabetes were associated with poor prognosis ( 12 ). Gao et al’s study identified baseline National Institutes of Health Stroke Scale (NIHSS) score, posterior circulation acute stroke prognosis early computed tomography (PC-ASPECT) score, and modified thrombolysis in cerebral infarction (mTICI) classification as independent risk factors affecting patients’ prognosis ( 13 ).…”