Long-term outcome changes after mechanical thrombectomy for anterior circulation acute ischemic stroke

• Published in: Journal of neurology Vol. 267; no. 4; pp. 1026 - 1034
• Main Authors: Fuhrer, Hannah, Forner, Lisa, Pruellage, Pascal, Weber, Susanne, Beume, Lena-Alexandra, Schacht, Hannes, Egger, Karl, Bardutzky, Juergen, Weiller, Cornelius, Urbach, Horst, Niesen, Wolf-Dirk, Meckel, Stephan
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.04.2020; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Cerebral Arterial Diseases - complications; Cerebral Arterial Diseases - therapy; Female; Hemispheric laterality; Humans; Ischemia; Ischemic Stroke - etiology; Ischemic Stroke - therapy; Longitudinal Studies; Male; Mechanical Thrombolysis - statistics & numerical data; Medicine; Medicine & Public Health; Middle Aged; Neurology; Neuroradiology; Neurosciences; Occlusion; Original Communication; Outcome Assessment, Health Care - statistics & numerical data; Patients; Registries; Rehabilitation; Stroke; Stroke; Thrombectomy; Ischemia; Outcome
• ISSN: 0340-5354; 1432-1459
• DOI: 10.1007/s00415-019-09670-w

Background and purpose Mechanical thrombectomy (MT) improves early clinical outcome in patients with acute ischemic stroke but insights on determinants of long-term outcome after MT treatment are scarce. Methods Data from stroke patients with anterior circulation large vessel occlusion of a prospective MT registry (01/2014–06/2017) of a large comprehensive stroke center were analyzed regarding clinical outcome between short- (3 months) and long-term (12 months) assessment reflected by a change of modified Rankin scores (∆mRS). Secondary endpoints included favorable long-term outcome (mRS 0–2). Multi-variable regression analysis was performed to identify determinants of outcome changes and favorable outcome at long term. Results Of 264 patients included, 42.0% showed a favorable long-term outcome. Longitudinal analysis found that some individuals still improved, but no overall mRS difference between short and long-term follow-up was detected [∆mRS − 0.004 (95% CI − 0.020; 0.013); p  = 0.672]. Right hemispheric stroke [∆mRS 0.286 (0.011; 0.561); p  = 0.043] and high NIHSS at discharge [∆mRS, 0.039 (0.004; 0.074); p  = 0.029] were associated with a longitudinal mRS decline. Favorable long-term outcome was associated with successful recanalization ( p  < 0.0001). Conclusions A significant number of patients with MT experience a favorable long-term outcome. Outcomes remained stable between short- and long-term follow-up, but some individuals may still show improvement beyond short-term rehabilitation. Right hemispheric stroke and clinical stroke severity at hospital discharge may be frail predictors for delayed decline of functional status, whereas successful recanalization remains a positive outcome predictor. Death rarely occurs beyond 3 months after MT treatment.