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Prognostic factors related to clinical outcome following thrombectomy in ischemic stroke (RECOST Study). 50 patients prospective study.
MedLine Citation:
PMID:  22940230     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND AND AIMS: New thrombectomy devices allow successful and rapid recanalization in acute ischemic stroke. Nevertheless prognostics factors need to be systematically analyzed in the context of these new therapeutic strategies. The aim of this study was to analyze prognostic factors related to clinical outcome following Solitaire FR thrombectomy in ischemic stroke. METHODS: Fifty consecutive ischemic stroke patients with large vessel occlusion were included. Three treatment strategies were applied; rescue therapy, combined therapy, and standalone thrombectomy. DWI ASPECT score<5 was the main exclusion criterion after initial MRI (T2, T2*, TOF, FLAIR, DWI). Sexes, age, time to recanalization were prospectively collected. Clinical outcome was assessed post treatment, day one and discharge by means of a NIHSS. Three months mRS evaluation was performed by an independent neurologist. The probability of good outcome at 3months was assessed by forward stepwise logistic regression using baseline NIHSS score, Glasgow score at entrance, hyperglycemia, dyslipidemia, blood-brain barrier disruption on post-operative CT, embolic and hemorrhagic post procedural complication, ischemic brain lesion extension on 24h imaging, NIHSS at discharge, ASPECT score, and time to recanalization. All variables significantly associated with the outcome in the univariate analysis were entered in the model. The significance of adding or removing a variable from the logistic model was determined by the maximum likelihood ratio test. Odds-ratio (OR) and their 95% confidence intervals were calculated. RESULTS: At 3months 54% of patients had a mRS 0-2, 70% in MCA, 44% in ICA, and 43% in BA with an overall mortality rate of 12%. Baseline NIHSS score (p=0.001), abnormal Glasgow score at entrance (p=0.053) hyperglycemia (p=0.023), dyslipidemia (p=0.031), blood-brain barrier disruption (p=0.022), embolic and hemorrhagic post procedural complication, ischemic brain lesion extension on 24h imaging (p=0.008), NIHSS at discharge (0.001) were all factors significantly associated with 3month clinical outcome. ASPECT subgroup (5-7 and 8-10), and time to recanalization were not correlated to 3months outcome. Baseline NIHSS score (OR, 1.228; 95% CI, 1.075-1.402; p=0.002), hyperglycemia (OR, 10.013; 95% CI, 1.068-93.915; p=0.04), emerged as independent predictors of outcome at 3months. Overall embolic complication rate was 10%, and symptomatic intracranial hemorrhage was 2%. CONCLUSION: The MCA location was associated with the best clinical outcome. A DWI ASPECT cutoff score of 5 was reliable and safe. No correlation with time to recanalization was observed in this study. NIHSS and hyperglycemia at admission were the two factors independently associated with a bad outcome at 90days.
Authors:
V Costalat; K Lobotesis; P Machi; I Mourand; I Maldonado; C Heroum; J F Vendrell; D Milhaud; C Riquelme; A Bonafé; C Arquizan
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-30
Journal Detail:
Title:  European journal of radiology     Volume:  -     ISSN:  1872-7727     ISO Abbreviation:  Eur J Radiol     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-9-3     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8106411     Medline TA:  Eur J Radiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
Affiliation:
CHU Montpellier, Neuroradiology, Montpellier, France.
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