Pretreatment predictors of very poor clinical outcomes in medium vessel occlusion stroke patients treated with mechanical thrombectomy

Vivek Yedavalli; Hamza Salim; Basel Musmar; Nimer Adeeb; Kareem El Naamani; Nils Henninger; Sri Hari Sundararajan; Anna Luisa Kühn; Jane Khalife; Sherief Ghozy; Luca Scarcia; Benjamin Yq Tan; Jeremy J Heit; Robert W Regenhardt; Nicole M Cancelliere; Joshua D Bernstock; Aymeric Rouchaud; Jens Fiehler; Sunil Sheth; Muhammed Amir Essibayi; Ajit S Puri; Christian Dyzmann; Marco Colasurdo; Xavier Barreau; Leonardo Renieri; João Pedro Filipe; Pablo Harker; Răzvan Alexandru Radu; Thomas R Marotta; Julian Spears; Takahiro Ota; Ashkan Mowla; Pascal Jabbour; Arundhati Biswas; Frédéric Clarençon; James E Siegler; Thanh N Nguyen; Ricardo Varela; Amanda Baker; David Altschul; Nestor R Gonzalez; Markus A Möhlenbruch; Vincent Costalat; Benjamin Gory; Christian Paul Stracke; Mohammad Ali Aziz-Sultan; Constantin Hecker; Hamza Shaikh; David S Liebeskind; Alessandro Pedicelli; Andrea M Alexandre; Illario Tancredi; Tobias D Faizy; Erwah Kalsoum; Boris Lubicz; Aman B Patel; Vitor Mendes Pereira; Adrien Guenego; Adam A Dmytriw; MAD MT Investigators

doi:10.1177/17474930241270524

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Pretreatment predictors of very poor clinical outcomes in medium vessel occlusion stroke patients treated with mechanical thrombectomy

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Pretreatment predictors of very poor clinical outcomes in medium vessel occlusion stroke patients treated with mechanical thrombectomy

Vivek Yedavalli, Hamza Salim, Basel Musmar, Nimer Adeeb, Kareem El Naamani, Nils Henninger, Sri Hari Sundararajan, Anna Luisa Kühn, Jane Khalife, Sherief Ghozy, …

International journal of stroke, Vol.19(10), pp.1123-1133

01/12/2024

DOI: https://doi.org/10.1177/17474930241270524

PMID: 39075759

Résumé

Age Factors

Aged

Aged, 80 and over

Female

Fibrinolytic Agents - therapeutic use

Humans

Ischemic Stroke - surgery

Ischemic Stroke - therapy

Male

Middle Aged

Registries

Retrospective Studies

Thrombectomy - methods

Tissue Plasminogen Activator - therapeutic use

Treatment Outcome

Acute ischemic stroke (AIS) from primary medium vessel occlusions (MeVO) is a prevalent condition associated with substantial morbidity and mortality. Despite the common use of mechanical thrombectomy (MT) in AIS, predictors of poor outcomes in MeVO remain poorly characterized. In this prospectively collected, retrospectively reviewed, multicenter, multinational study, data from the MAD-MT (Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy) registry were analyzed. The study included 1568 patients from 37 academic centers across North America, Asia, and Europe, treated with MT, with or without intravenous tissue plasminogen activator (IVtPA), between September 2017 and July 2021. Among the 1568 patients, 347 (22.2%) experienced very poor outcomes (modified Rankin score (mRS), 5-6). Key predictors of poor outcomes were advanced age (odds ratio (OR): 1.03; 95% confidence interval (CI): 1.02 to 1.04; p < 0.001), higher baseline National Institutes of Health Stroke Scale (NIHSS) scores (OR: 1.07; 95% CI: 1.05 to 1.10; p < 0.001), pre-operative glucose levels (OR: 1.01; 95% CI: 1.00 to 1.02; p < 0.001), and a baseline mRS of 4 (OR: 2.69; 95% CI: 1.25 to 5.82; p = 0.011). The multivariable model demonstrated good predictive accuracy with an area under the receiver-operating characteristic (ROC) curve of 0.76. This study demonstrates that advanced age, higher NIHSS scores, elevated pre-stroke mRS, and pre-operative glucose levels significantly predict very poor outcomes in AIS-MeVO patients who received MT. These findings highlight the importance of a comprehensive risk assessment in primary MeVO patients for personalized treatment strategies. However, they also suggest a need for cautious patient selection for endovascular thrombectomy. Further prospective studies are needed to confirm these findings and explore targeted therapeutic interventions.

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Détails

Titre: Pretreatment predictors of very poor clinical outcomes in medium vessel occlusion stroke patients treated with mechanical thrombectomy
Créateurs - sans rôle: Vivek Yedavalli - Division of Neuroradiology, Department of Radiology, Johns Hopkins Medical Center, Baltimore, MD, USA
Hamza Salim - Harvard University
Basel Musmar - Louisiana State University
Nimer Adeeb - Louisiana State University
Kareem El Naamani - Thomas Jefferson University
Nils Henninger - Beth Israel Deaconess Medical Center
Sri Hari Sundararajan - Department of Endovascular Neurosurgery and Neuroradiology NJMS, Newark, NJ, USA
Anna Luisa Kühn - Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA
Jane Khalife - Cooper Medical School of Rowan University
Sherief Ghozy - Neurological Surgery
Luca Scarcia - Department of Neuroradiology, Henri Mondor Hospital, Creteil, France
Benjamin Yq Tan - Division of Neurology, Department of Medicine, National University Hospital, Singapore
Jeremy J Heit - Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA
Robert W Regenhardt - Harvard University
Nicole M Cancelliere - Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
Joshua D Bernstock - Brigham and Women's Hospital
Aymeric Rouchaud - University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France
Jens Fiehler - University Medical Center Hamburg-Eppendorf
Sunil Sheth - The University of Texas Health Science Center at Houston
Muhammed Amir Essibayi - Albert Einstein College of Medicine
Ajit S Puri - Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA
Christian Dyzmann - Neuroradiology Department, Sana Kliniken, Lübeck GmbH, Lübeck, Germany
Marco Colasurdo - Oregon Health & Science University
Xavier Barreau - Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France
Leonardo Renieri - Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy
João Pedro Filipe - Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal
Pablo Harker - University of Cincinnati Medical Center
Răzvan Alexandru Radu - Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
Thomas R Marotta - Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
Julian Spears - Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
Takahiro Ota - Tokyo Metropolitan Tama Medical Center
Ashkan Mowla - Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
Pascal Jabbour - Thomas Jefferson University
Arundhati Biswas - Westchester Medical Center
Frédéric Clarençon - Pitié-Salpêtrière Hospital
James E Siegler - Cooper Medical School of Rowan University
Thanh N Nguyen - Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA
Ricardo Varela - Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal
Amanda Baker - Albert Einstein College of Medicine
David Altschul - Albert Einstein College of Medicine
Nestor R Gonzalez - Cedars-Sinai Medical Center
Markus A Möhlenbruch - Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
Vincent Costalat - Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
Benjamin Gory - Université de Lorraine
Christian Paul Stracke - Department of Radiology, Interventional Neuroradiology Section, University Medical Center Münster, Münster, Germany
Mohammad Ali Aziz-Sultan - Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston MA, USA
Constantin Hecker - Paracelsus Medical University
Hamza Shaikh - Cooper Medical School of Rowan University
David S Liebeskind - UCLA Stroke Center and Department of Neurology Department, University of California, Los Angeles, Los Angeles, CA, USA
Alessandro Pedicelli - UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
Andrea M Alexandre - UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
Illario Tancredi - Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium
Tobias D Faizy - Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Münster, Germany
Erwah Kalsoum - Department of Neuroradiology, Henri Mondor Hospital, Creteil, France
Boris Lubicz - Universitair Ziekenhuis Brussel
Aman B Patel - Harvard University
Vitor Mendes Pereira - Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
Adrien Guenego - Universitair Ziekenhuis Brussel
Adam A Dmytriw - Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
MAD MT Investigators
Détails de publication: International journal of stroke, Vol.19(10), pp.1123-1133
Identifiants: 99162973609311
Unité académique: Institut de Génomique Fonctionnelle - IGF
Langue: English
Type de ressource: Journal article