The Charlotte large artery occlusion endovascular therapy outcome score predicts outcome after basilar artery thrombectomy

Karamchandani, Rahul R; Satyanarayana, Sagar; Yang, Hongmei; Defilipp, Gary; Strong, Dale; Rhoten, Jeremy B; Patel, Nikhil M; Asimos, Andrew W

doi:10.1111/jon.13039

Cited by 4 publications

(1 citation statement)

References 19 publications

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“…This was the case for most high weighted studies, apart from Chen et al (2020). Shriki et al (2020) and Karamchandani et al (2022) displayed non-significant differences in the opposite direction but were small, low weighted studies. Risk of bias was low overall (mean 11.94/14) and studies with a moderate risk of bias were evenly distributed in terms of their weights.…”

Section: Continuous (Ratio) Glucose (Mmol/l)mentioning

confidence: 80%

Associations between basic physiological observations recorded pre-thrombectomy and functional outcome: a systematic review and meta-analysis

Lumley,

Shaw,

Morris

et al. 2023

Front. Stroke

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IntroductionMechanical thrombectomy results in more favourable functional outcomes for patients with acute large vessel occlusion (LVO) stroke. Key clinical determinants of thrombectomy outcome include symptom severity, age and time from onset to treatment, but associations have also been reported with baseline physiological observations including systolic/diastolic blood pressure (SBP/DBP), blood/serum glucose, atrial fibrillation and conscious level. As these items are routinely available during initial emergency assessment, they might help to inform early prehospital and hospital triage decisions if evidence consistently shows associations with post-thrombectomy outcome. We undertook a meta-analysis of studies reporting pre-thrombectomy physiological observations and functional outcome.MethodPRISMA guidelines were followed to search electronic bibliographies, select articles and extract data. Medline, PubMed, Cochrane HTA, Cochrane Central and Embase were searched. Included articles were observational or interventional thrombectomy studies published between 01/08/2004-19/04/2023 reporting 3-month modified Rankin Scale, split as favourable (0–2) and unfavourable (3–6). A modified version of the Quality in Prognostic Studies (QUIPS) tool was used to assess risk of bias. RevMan 5 was used to calculate Inverse Variance with Weighted Mean Differences (WMD) and Mantel-Haenszel Odds Ratios (OR) for continuous and categorical factors respectively.ResultsThirty seven studies were eligible from 8,687 records. Significant associations were found between unfavourable outcome and higher blood/serum glucose as a continuous (WMD = 1.34 mmol/l (95%CI 0.97 to 1.72); 19 studies; n = 3122) and categorical (OR = 2.44 (95%CI 1.9 to 3.14) variable; 6 studies; n = 5481), higher SBP (WMD = 2.98 mmHg (95%CI 0.86 to 5.11); 16 studies; n = 4,400), atrial fibrillation (OR = 1.48 (95%CI 1.08 to 2.03); 3 studies; n = 736), and lower Glasgow Coma Scale (WMD = −2.72 (95%CI −4.01 to −1.44); 2 studies; n = 99). No association was found with DBP (WMD = 0.36 mmHg (95%CI −0.76 to 1.49); 13 studies; n = 3,614).ConclusionBasic physiological observations might assist early triage decisions for thrombectomy and could be used in combination with other information to avoid futile treatment and ambulance transfers. It is important to acknowledge that data were only from thrombectomy treated patients in hospital settings and it cannot be assumed that the predictors identified are independent or that modification can change outcome. Further work is needed to establish the optimal combination of prognostic factors for clinical care decisions.

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Section: Continuous (Ratio) Glucose (Mmol/l)mentioning

confidence: 80%

Associations between basic physiological observations recorded pre-thrombectomy and functional outcome: a systematic review and meta-analysis

Lumley,

Shaw,

Morris

et al. 2023

Front. Stroke

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The charlotte large artery occlusion endovascular therapy outcome score compares favorably to the critical area perfusion score for prognostication before basilar thrombectomy

Karamchandani¹,

Satyanarayana²,

Yang³

et al. 2023

Journal of Stroke and Cerebrovascular Diseases

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Predictors of devastating functional outcome despite successful basilar thrombectomy

Karamchandani,

Satyanarayana,

Yang

et al. 2023

Interv Neuroradiol

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Background Basilar thrombosis frequently leads to poor functional outcomes, even with good endovascular reperfusion. We studied factors associated with severe disability or death in basilar thrombectomy patients achieving revascularization. Methods We retrospectively analyzed records from a health system's code stroke registry, including successful basilar thrombectomy patients from January 2017 to May 2023 who were evaluated with pretreatment computed tomography perfusion. The primary outcome was devastating functional outcome (90-day modified Rankin Scale [mRS] score 5–6). A multivariable logistic regression model was constructed to determine independent predictors of the primary outcome. The area under the receiver operator characteristics curve (AUC) was calculated for the model distinguishing good from devastating outcome. Results Among 64 included subjects, with mean (standard deviation) age 65.6 (14.1) years and median (interquartile range) National Institutes of Health Stroke Scale (NIHSS) 18 (5.75–24.5), the primary outcome occurred in 28 of 64 (43.8%) subjects. Presenting NIHSS (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.01–1.14, p = 0.02), initial glucose (OR 0.99, 95% CI 0.97–1.00, p < 0.05), and proximal occlusion site (OR 7.38, 95% CI 1.84–29.60, p < 0.01) were independently associated with 90-day mRS 5–6. The AUC for the multivariable model distinguishing outcomes was 0.81 (95% CI 0.70–0.92). Conclusion We have identified presenting stroke severity, lower glucose, and proximal basilar occlusion as predictors of devastating neurological outcome in successful basilar thrombectomy patients. These factors may be used in medical decision making or for patient selection in future clinical trials.

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The Charlotte large artery occlusion endovascular therapy outcome score predicts outcome after basilar artery thrombectomy

Cited by 4 publications

References 19 publications

Associations between basic physiological observations recorded pre-thrombectomy and functional outcome: a systematic review and meta-analysis

Associations between basic physiological observations recorded pre-thrombectomy and functional outcome: a systematic review and meta-analysis

The charlotte large artery occlusion endovascular therapy outcome score compares favorably to the critical area perfusion score for prognostication before basilar thrombectomy

Predictors of devastating functional outcome despite successful basilar thrombectomy

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