Predictors of functional outcome after thrombectomy for M2 occlusions: a large scale experience from clinical practice.
Journal
Scientific reports
ISSN: 2045-2322
Titre abrégé: Sci Rep
Pays: England
ID NLM: 101563288
Informations de publication
Date de publication:
31 10 2023
31 10 2023
Historique:
received:
18
02
2023
accepted:
17
10
2023
medline:
2
11
2023
pubmed:
1
11
2023
entrez:
1
11
2023
Statut:
epublish
Résumé
Mechanical thrombectomy (MT) for acute ischemic stroke with medium vessel occlusions is still a matter of debate. We sought to identify factors associated with clinical outcome after MT for M2-occlusions based on data from the German Stroke Registry-Endovascular Treatment (GSR-ET). All patients prospectively enrolled in the GSR-ET from 05/2015 to 12/2021 were analyzed (NCT03356392). Inclusion criteria were primary M2-occlusions and availability of relevant clinical data. Factors associated with excellent/good outcome (modified Rankin scale mRS 0-1/0-2), poor outcome/death (mRS 5-6) and mRS-increase pre-stroke to day 90 were determined in multivariable logistic regression. 1348 patients were included. 1128(84%) had successful recanalization, 595(44%) achieved good outcome, 402 (30%) had poor outcome. Successful recanalization (odds ratio [OR] 4.27 [95% confidence interval 3.12-5.91], p < 0.001), higher Alberta stroke program early CT score (OR 1.25 [1.18-1.32], p < 0.001) and i.v. thrombolysis (OR 1.28 [1.07-1.54], p < 0.01) increased probability of good outcome, while age (OR 0.95 [0.94-0.95], p < 0.001), higher pre-stroke-mRS (OR 0.36 [0.31-0.40], p < 0.001), higher baseline NIHSS (OR 0.89 [0.88-0.91], p < 0.001), diabetes (OR 0.52 [0.42-0.64], p < 0.001), higher number of passes (OR 0.75 [0.70-0.80], p < 0.001) and intracranial hemorrhage (OR 0.26 [0.14-0.46], p < 0.001) decreased the probability of good outcome. Additional predictors of mRS-increase pre-stroke to 90d were dissections, perforations (OR 1.59 [1.11-2.29], p < 0.05) and clot migration, embolization (OR 1.67 [1.21-2.30], p < 0.01). Corresponding to large-vessel-occlusions, younger age, low pre-stroke-mRS, low severity of acute clinical disability, i.v. thrombolysis and successful recanalization were associated with good outcome while diabetes and higher number of passes decreased probability of good outcome after MT in M2 occlusions. Treatment related complications increased probability of mRS increase pre-stroke to 90d.
Identifiants
pubmed: 37907482
doi: 10.1038/s41598-023-45232-x
pii: 10.1038/s41598-023-45232-x
pmc: PMC10618211
doi:
Banques de données
ClinicalTrials.gov
['NCT03356392']
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
18740Investigateurs
Joachim Röther
(J)
Bernd Eckert
(B)
Michael Braun
(M)
Gerhard F Hamann
(GF)
Eberhard Siebert
(E)
Christian Nolte
(C)
Sarah Zweynert
(S)
Georg Bohner
(G)
Jörg Berrouschot
(J)
Albrecht Bormann
(A)
Christoffer Kraemer
(C)
Hannes Leischner
(H)
Jörg Hattingen
(J)
Martina Petersen
(M)
Florian Stögbauer
(F)
None Boeckh-Behrens
Silke Wunderlich
(S)
Alexander Ludolph
(A)
Karl-Heinz Henn
(KH)
Christian Gerloff
(C)
Jens Fiehler
(J)
Götz Thomalla
(G)
Anna Alegiani
(A)
Maximilian Schell
(M)
Arno Reich
(A)
Omid Nikoubashman
(O)
Franziska Dorn
(F)
Gabor Petzold
(G)
Jan Liman
(J)
Jan Hendrik Schäfer
(JH)
Fee Keil
(F)
Klaus Gröschel
(K)
Timo Uphaus
(T)
Peter Schellinger
(P)
Jan Borggrefe
(J)
Steffen Tiedt
(S)
Lars Kellert
(L)
Christoph Trumm
(C)
Ulrike Ernemann
(U)
Sven Poli
(S)
Christian Riedel
(C)
Marielle Sophie Ernst
(MS)
Informations de copyright
© 2023. The Author(s).
Références
Stroke. 2022 Oct;53(10):3072-3081
pubmed: 35735007
N Engl J Med. 2015 Jun 11;372(24):2285-95
pubmed: 25882376
World Neurosurg. 2022 Apr;160:e566-e572
pubmed: 35077884
Stroke. 2015 Jul;46(7):1877-82
pubmed: 25967573
Transl Stroke Res. 2021 Dec;12(6):968-975
pubmed: 33576937
Neurology. 2019 Jun 4;92(23):e2626-e2643
pubmed: 31043475
Stroke. 2019 Aug;50(8):2140-2146
pubmed: 31216965
Ann Neurol. 2022 May;91(5):629-639
pubmed: 35184327
World Neurosurg. 2017 Nov;107:684-691
pubmed: 28844911
Stroke. 2018 Mar;49(3):e46-e110
pubmed: 29367334
Circulation. 2015 Jan 13;131(2):211-9
pubmed: 25561516
Stroke. 2018 Sep;49(9):2108-2115
pubmed: 30354986
J Neurol Neurosurg Psychiatry. 2020 Oct;91(10):1055-1059
pubmed: 32934109
AJNR Am J Neuroradiol. 2021 Oct;42(10):1834-1838
pubmed: 34413064
Stroke. 2020 Sep;51(9):2872-2884
pubmed: 32757757
J Neurointerv Surg. 2021 Dec;13(12):1117-1123
pubmed: 33443119
J Neurointerv Surg. 2022 Apr;14(4):350-355
pubmed: 33947769
J Neurointerv Surg. 2019 Nov;11(11):1065-1069
pubmed: 30975736
J Neurointerv Surg. 2021 Jul;13(7):623-630
pubmed: 33637570
Int J Stroke. 2019 Jun;14(4):372-380
pubmed: 30346260
Stroke. 2019 Jul;50(7):1781-1788
pubmed: 31177974
Stroke. 2021 Jan;52(2):482-490
pubmed: 33467875
Stroke. 2018 Jul;49(7):1662-1668
pubmed: 29915125
JAMA. 2013 Nov 27;310(20):2191-4
pubmed: 24141714
Int J Stroke. 2019 Jan;14(1):23-31
pubmed: 30188259
Neurosurgery. 2017 Nov 1;81(5):795-802
pubmed: 28328002
J Stroke. 2019 Sep;21(3):347-349
pubmed: 31590479
Stroke. 2019 Sep;50(9):2500-2506
pubmed: 31337298
AJNR Am J Neuroradiol. 2020 Feb;41(2):280-285
pubmed: 32001443
J Neurol. 2020 Feb;267(2):440-448
pubmed: 31667625
Lancet. 2016 Apr 23;387(10029):1723-31
pubmed: 26898852