Predictors of Functional Dependence Despite Successful Revascularization in Large-Vessel Occlusion Strokes

• Published in: Stroke (1970) Vol. 45; no. 7; pp. 1977 - 1984
• Main Authors: Shi, Zhong-Song, Liebeskind, David S., Xiang, Bin, Ge, Sijian Grace, Feng, Lei, Albers, Gregory W., Budzik, Ronald, Devlin, Thomas, Gupta, Rishi, Jansen, Olav, Jovin, Tudor G., Killer-Oberpfalzer, Monika, Lutsep, Helmi L., Macho, Juan, Nogueira, Raul G., Rymer, Marilyn, Smith, Wade S., Wahlgren, Nils, Duckwiler, Gary R.
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD American Heart Association, Inc 01.07.2014; Lippincott Williams & Wilkins
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Brain Infarction - epidemiology; Brain Infarction - physiopathology; Brain Ischemia - drug therapy; Brain Ischemia - epidemiology; Brain Ischemia - physiopathology; Cerebral Revascularization - standards; Cerebral Revascularization - statistics & numerical data; Clinical Trials as Topic; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Male; Medical sciences; Middle Aged; Multicenter Studies as Topic; Nervous system (semeiology, syndromes); Neurology; Predictive Value of Tests; Recovery of Function - physiology; Severity of Illness Index; Stroke - drug therapy; Stroke - epidemiology; Stroke - physiopathology; Thrombectomy - standards; Thrombectomy - statistics & numerical data; Thrombolytic Therapy - standards; Thrombolytic Therapy - statistics & numerical data; Vascular diseases and vascular malformations of the nervous system; Vascular disease; Stroke; Nervous system diseases; Central nervous system disease; Functional dependence; Cardiovascular disease; Cerebrovascular disease; Cerebral disorder; Revascularization; stroke
• ISSN: 0039-2499; 1524-4628; 1524-4628
• DOI: 10.1161/STROKEAHA.114.005603

BACKGROUND AND PURPOSE—High revascularization rates in large-vessel occlusion strokes treated by mechanical thrombectomy are not always associated with good clinical outcomes. We evaluated predictors of functional dependence despite successful revascularization among patients with acute ischemic stroke treated with thrombectomy. METHODS—We analyzed the pooled data from the Multi Mechanical Embolus Removal in Cerebral Ischemia (MERCI), Thrombectomy Revascularization of Large Vessel Occlusions in Acute Ischemic Stroke (TREVO), and TREVO 2 trials. Successful revascularization was defined as thrombolysis in cerebral infarction score 2b or 3. Functional dependence was defined as a score of 3 to 6 on the modified Rankin Scale at 3 months. We assessed relationship of demographic, clinical, angiographic characteristics, and hemorrhage with functional dependence despite successful revascularization. RESULTS—Two hundred and twenty-eight patients with successful revascularization had clinical outcome follow-up. The rates of functional dependence with endovascular success were 48.6% for Trevo thrombectomy and 58.0% for Merci thrombectomy. Age (odds ratio, 1.04; 95% confidence interval, 1.02–1.06 per 1-year increase), National Institutes of Health Stroke Scale score (odds ratio, 1.08; 95% confidence interval, 1.02–1.15 per 1-point increase), and symptom onset to endovascular treatment time (odds ratio, 1.11; 95% confidence interval, 1.01–1.22 per 30-minute delay) were predictors of functional dependence despite successful revascularization. Symptom onset to reperfusion time beyond 5 hours was associated with functional dependence. All subjects with symptomatic intracranial hemorrhage had functional dependence. CONCLUSIONS—One half of patients with successful mechanical thrombectomy do not have good outcomes. Age, severe neurological deficits, and delayed endovascular treatment were associated with functional dependence despite successful revascularization. Our data support efforts to minimize delays to endovascular therapy in patients with acute ischemic stroke to improve outcomes. CLINICAL TRIAL REGISTRATION—URLhttp://www.clinicaltrials.gov. Unique identifierNCT00318071, NCT01088672, and NCT01270867.