TOPLINE:

More than half of the participants with acute ischemic stroke (AIS) had poor outcomes after endovascular therapy (EVT) in a new retrospective study. Age, preoperative neurologic status, and postsurgical complications were among the key predictors of treatment outcomes. 

METHODOLOGY:

• A retrospective analysis included more than 300 patients with AIS (mean age, 65.5 years; 66% men; 73% with anterior circulation stroke) who received emergency EVT between 2015 and 2019.
• All patients underwent head CT immediately after surgery to detect intracranial hemorrhage (ICH). Follow-up head CT or MRI was performed at 24 hours, 7 days, and 30 days to evaluate infarct volume and hemorrhagic transformation.
• The main outcome was functional status at discharge, as measured with the modified Rankin Scale (mRS).
• Other outcomes included neurologic impairment and complications such as symptomatic ICH, defined as ICH with a National Institutes of Health Stroke Scale (NIHSS) score increase ≥ 4; infarct volume assessed via the Alberta Stroke Program Early CT Score (ASPECTS); vessel recanalization evaluated via thrombolysis in cerebral infarction (TICI) grade; and cerebral edema/hernia.

TAKEAWAY:

• At discharge, 53% of participants had poor outcomes (mRS score, 3-6), whereas the remainder had good outcomes (mRS score, 0-2).
• Independent risk factors for poor outcomes included age (P = .01), preoperative NIHSS score (P < .001), preoperative ASPECTS scores of 6-7 and ≥ 8 vs scores ≤ 5 (P < .001 for both comparisons), post-EVT TICI grades of 2b and 2c-3 vs 0-2a (P < .001 for both), and postoperative symptomatic ICH (P = .001) or cerebral edema/hernia (P = .004).
• History of atrial fibrillation and previous stroke were not independent predictors of outcomes.

IN PRACTICE:

For patients with these identified factors, “prognosis should be carefully evaluated and the treatment plan adjusted in time to improve the efficacy and safety of endovascular interventional therapy,” the investigators wrote. 

“In future, it is necessary to establish a more complete evaluation and prediction system to help guide the precise treatment of acute ischemic stroke,” they added.

SOURCE:

This study was led by Kai Wang, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China. It was published online on October 14 in BMC Neurology.

LIMITATIONS:

This study was limited by its single-center retrospective design and relatively small sample size. Incomplete data collection precluded the analysis of key prognostic factors, including collateral circulation status and use of general anesthesia. Only short-term outcomes at discharge were evaluated, and long-term follow-up data were not available. Additionally, the absence of a comparison group, such as patients treated with intravenous thrombolysis or untreated patients, limited causal inference. 

DISCLOSURES:

The investigators reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.