Predictors of a Good Outcome after Endovascular Stroke Treatment with Stent Retrievers
Background and Purpose. Successful recanalization after endovascular stroke therapy (EVT) did not translate into a good clinical outcome in randomized trials. The goal of the study was to identify the predictors of a good outcome after mechanical thrombectomy with stent retrievers. Methods. A retros...
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| Format: | Article |
| Language: | English |
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Wiley
2015-01-01
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| Series: | The Scientific World Journal |
| Online Access: | http://dx.doi.org/10.1155/2015/403726 |
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| author | Ozcan Ozdemir Semih Giray Zulfikar Arlier Demet Funda Baş Yusuf Inanc Ertugrul Colak |
| author_facet | Ozcan Ozdemir Semih Giray Zulfikar Arlier Demet Funda Baş Yusuf Inanc Ertugrul Colak |
| author_sort | Ozcan Ozdemir |
| collection | DOAJ |
| description | Background and Purpose. Successful recanalization after endovascular stroke therapy (EVT) did not translate into a good clinical outcome in randomized trials. The goal of the study was to identify the predictors of a good outcome after mechanical thrombectomy with stent retrievers. Methods. A retrospective analysis of a prospectively collected database included consecutive patients treated with stent retrievers. We evaluated the influence of risk factors for stroke, baseline NIHSS score, Alberta Stroke Program Early CT (ASPECT) score, recanalization rate, onset-to-recanalization and onset-to-groin puncture time, and glucose levels at admission on good outcomes. The number of stent passes during procedure and symptomatic hemorrhage rate were also recorded. A modified Rankin Scale (mRS) score of 0–2 at 90 days was considered as a good outcome. Results. From January 2011 to 2014, 70 consecutive patients with an acute ischemic stroke underwent EVT with stent retrievers. The absence of a medical history of diabetes was associated with good outcomes. Apart from diabetes, the baseline demographic and clinical characteristics of patients were similar between subjects with poor outcome versus those with good outcomes. Median time from onset to recanalization was significantly shorter in patients with good outcomes 245 (IQR: 216–313 min) compared with poor outcome patients (315 (IQR: 240–360 min); P=0.023). Symptomatic intracranial hemorrhage was observed in eight (21.6%) of 37 patients with poor outcomes and no symptomatic hemorrhage was seen in patients with good outcomes (P=0.006). In multivariate stepwise logistic regression analysis, a favorable ASPECT score (ASPECT > 7) and successful recanalization after EVT were predictors of good outcomes. Every 10-year increase was associated with a 3.60-fold decrease in the probability of a good outcome at 3 months. The probability of a good outcome decreases by 1.43-fold for each 20 mg/dL increase in the blood glucose at admission. Conclusion. To achieve a good outcome after EVT with stent retrievers, quick and complete recanalization and better strategies for patient selection are warranted. We need randomized trials to identify the significance of tight blood glucose control in clinical outcome during or after EVT. |
| format | Article |
| id | doaj-art-91a3bc72dea8454d9d4c3ba7a4adf03f |
| institution | Kabale University |
| issn | 2356-6140 1537-744X |
| language | English |
| publishDate | 2015-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | The Scientific World Journal |
| spelling | doaj-art-91a3bc72dea8454d9d4c3ba7a4adf03f2025-02-03T06:14:12ZengWileyThe Scientific World Journal2356-61401537-744X2015-01-01201510.1155/2015/403726403726Predictors of a Good Outcome after Endovascular Stroke Treatment with Stent RetrieversOzcan Ozdemir0Semih Giray1Zulfikar Arlier2Demet Funda Baş3Yusuf Inanc4Ertugrul Colak5Department of Neurology, Eskisehir Osmangazi University Medical Faculty, Neurocritical Care, Cerebrovascular Disease, 26040 Eskisehir, TurkeyDepartment of Neurology, Baskent University Medical Faculty, Ankara, TurkeyDepartment of Neurology, Baskent University Medical Faculty, Ankara, TurkeyDepartment of Neurology, Eskisehir Osmangazi University Medical Faculty, Neurocritical Care, Cerebrovascular Disease, 26040 Eskisehir, TurkeyDepartment of Neurology, Baskent University Medical Faculty, Ankara, TurkeyDepartment of Biostatistics, Eskisehir Osmangazi University, TurkeyBackground and Purpose. Successful recanalization after endovascular stroke therapy (EVT) did not translate into a good clinical outcome in randomized trials. The goal of the study was to identify the predictors of a good outcome after mechanical thrombectomy with stent retrievers. Methods. A retrospective analysis of a prospectively collected database included consecutive patients treated with stent retrievers. We evaluated the influence of risk factors for stroke, baseline NIHSS score, Alberta Stroke Program Early CT (ASPECT) score, recanalization rate, onset-to-recanalization and onset-to-groin puncture time, and glucose levels at admission on good outcomes. The number of stent passes during procedure and symptomatic hemorrhage rate were also recorded. A modified Rankin Scale (mRS) score of 0–2 at 90 days was considered as a good outcome. Results. From January 2011 to 2014, 70 consecutive patients with an acute ischemic stroke underwent EVT with stent retrievers. The absence of a medical history of diabetes was associated with good outcomes. Apart from diabetes, the baseline demographic and clinical characteristics of patients were similar between subjects with poor outcome versus those with good outcomes. Median time from onset to recanalization was significantly shorter in patients with good outcomes 245 (IQR: 216–313 min) compared with poor outcome patients (315 (IQR: 240–360 min); P=0.023). Symptomatic intracranial hemorrhage was observed in eight (21.6%) of 37 patients with poor outcomes and no symptomatic hemorrhage was seen in patients with good outcomes (P=0.006). In multivariate stepwise logistic regression analysis, a favorable ASPECT score (ASPECT > 7) and successful recanalization after EVT were predictors of good outcomes. Every 10-year increase was associated with a 3.60-fold decrease in the probability of a good outcome at 3 months. The probability of a good outcome decreases by 1.43-fold for each 20 mg/dL increase in the blood glucose at admission. Conclusion. To achieve a good outcome after EVT with stent retrievers, quick and complete recanalization and better strategies for patient selection are warranted. We need randomized trials to identify the significance of tight blood glucose control in clinical outcome during or after EVT.http://dx.doi.org/10.1155/2015/403726 |
| spellingShingle | Ozcan Ozdemir Semih Giray Zulfikar Arlier Demet Funda Baş Yusuf Inanc Ertugrul Colak Predictors of a Good Outcome after Endovascular Stroke Treatment with Stent Retrievers The Scientific World Journal |
| title | Predictors of a Good Outcome after Endovascular Stroke Treatment with Stent Retrievers |
| title_full | Predictors of a Good Outcome after Endovascular Stroke Treatment with Stent Retrievers |
| title_fullStr | Predictors of a Good Outcome after Endovascular Stroke Treatment with Stent Retrievers |
| title_full_unstemmed | Predictors of a Good Outcome after Endovascular Stroke Treatment with Stent Retrievers |
| title_short | Predictors of a Good Outcome after Endovascular Stroke Treatment with Stent Retrievers |
| title_sort | predictors of a good outcome after endovascular stroke treatment with stent retrievers |
| url | http://dx.doi.org/10.1155/2015/403726 |
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