Predictors of futile recanalization in ischemic stroke patients with low baseline NIHSS.

IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY
International Journal of Stroke Pub Date : 2024-12-01 Epub Date: 2024-11-19 DOI:10.1177/17474930241264737
Christian Heitkamp, Alexander Heitkamp, Laurens Winkelmeier, Christian Thaler, Fabian Flottmann, Maximilian Schell, Helge C Kniep, Gabriel Broocks, Jeremy J Heit, Gregory W Albers, Götz Thomalla, Jens Fiehler, Tobias D Faizy
{"title":"Predictors of futile recanalization in ischemic stroke patients with low baseline NIHSS.","authors":"Christian Heitkamp, Alexander Heitkamp, Laurens Winkelmeier, Christian Thaler, Fabian Flottmann, Maximilian Schell, Helge C Kniep, Gabriel Broocks, Jeremy J Heit, Gregory W Albers, Götz Thomalla, Jens Fiehler, Tobias D Faizy","doi":"10.1177/17474930241264737","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>There is yet no randomized controlled evidence that mechanical thrombectomy (MT) is superior to best medical treatment in patients with large vessel occlusion but minor stroke symptoms (National Institutes of Health Stroke Scale (NIHSS) <6). Prior studies of patients with admission NIHSS scores <b>≥</b>6 observed unfavorable functional outcomes despite successful recanalization, commonly termed as futile recanalization (FR), in up to 50% of cases.</p><p><strong>Aim: </strong>The aim of this study is to determine the prevalence of FR in patients with minor stroke and identify associated patient-specific risk factors.</p><p><strong>Methods: </strong>Our multicenter cohort study screened all patients prospectively enrolled in the German Stroke Registry Endovascular Treatment from 2015 to 2021 (n = 13,082). Included were patients who underwent MT for anterior circulation vessel occlusion with a baseline NIHSS score of <6 and successful recanalization (modified Thrombolysis in Cerebral Infarction (mTICI) scores of 2b-3). FR was defined by modified Rankin Scale (mRS) scores of 2-6 at 90 days. Multivariable logistic regression analysis was conducted to explore factors associated with FR.</p><p><strong>Results: </strong>A total of 674 patients met the inclusion criteria. FR occurred in 268 (40%) patients. Multivariable logistic regression analysis indicates that higher age (adjusted odds ratio (aOR) = 1.04 (95% confidence interval (CI) = 1.02-1.06)), pre-stroke mRS 1 (aOR = 2.70 (95% CI = 1.51-4.84)), transfer from admission hospital to comprehensive stroke center (aOR = 1.67 (95% CI = 1.08-2.56)), longer time from symptom onset/last seen well to admission (aOR = 1.02 (95% CI = 1.00-1.04)), MT under general anesthesia (aOR = 1.78 (95% CI = 1.13-2.82)), higher NIHSS after 24 h (aOR = 1.09 (95% CI = 1.05-1.14)), and symptomatic intracranial hemorrhage (aOR = 16.88 (95% CI = 2.03-140.14)) increased the odds of FR. There was no significant difference in primary outcome between achieving mTICI score of 2b or 3.</p><p><strong>Conclusions: </strong>Unfavorable functional outcomes despite successful vessel recanalization were frequent in acute ischemic stroke patients with low NIHSS scores on admission. We provide patient-specific risk factors that indicate an increased risk of FR and should be considered when treating patients with minor stroke.</p><p><strong>Data accessibility statement: </strong>The data that support the findings of our study are available on reasonable request after approval of the German Stroke Registry (GSR) steering committee.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1102-1112"},"PeriodicalIF":6.3000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11590392/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Stroke","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/17474930241264737","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/11/19 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Background: There is yet no randomized controlled evidence that mechanical thrombectomy (MT) is superior to best medical treatment in patients with large vessel occlusion but minor stroke symptoms (National Institutes of Health Stroke Scale (NIHSS) <6). Prior studies of patients with admission NIHSS scores 6 observed unfavorable functional outcomes despite successful recanalization, commonly termed as futile recanalization (FR), in up to 50% of cases.

Aim: The aim of this study is to determine the prevalence of FR in patients with minor stroke and identify associated patient-specific risk factors.

Methods: Our multicenter cohort study screened all patients prospectively enrolled in the German Stroke Registry Endovascular Treatment from 2015 to 2021 (n = 13,082). Included were patients who underwent MT for anterior circulation vessel occlusion with a baseline NIHSS score of <6 and successful recanalization (modified Thrombolysis in Cerebral Infarction (mTICI) scores of 2b-3). FR was defined by modified Rankin Scale (mRS) scores of 2-6 at 90 days. Multivariable logistic regression analysis was conducted to explore factors associated with FR.

Results: A total of 674 patients met the inclusion criteria. FR occurred in 268 (40%) patients. Multivariable logistic regression analysis indicates that higher age (adjusted odds ratio (aOR) = 1.04 (95% confidence interval (CI) = 1.02-1.06)), pre-stroke mRS 1 (aOR = 2.70 (95% CI = 1.51-4.84)), transfer from admission hospital to comprehensive stroke center (aOR = 1.67 (95% CI = 1.08-2.56)), longer time from symptom onset/last seen well to admission (aOR = 1.02 (95% CI = 1.00-1.04)), MT under general anesthesia (aOR = 1.78 (95% CI = 1.13-2.82)), higher NIHSS after 24 h (aOR = 1.09 (95% CI = 1.05-1.14)), and symptomatic intracranial hemorrhage (aOR = 16.88 (95% CI = 2.03-140.14)) increased the odds of FR. There was no significant difference in primary outcome between achieving mTICI score of 2b or 3.

Conclusions: Unfavorable functional outcomes despite successful vessel recanalization were frequent in acute ischemic stroke patients with low NIHSS scores on admission. We provide patient-specific risk factors that indicate an increased risk of FR and should be considered when treating patients with minor stroke.

Data accessibility statement: The data that support the findings of our study are available on reasonable request after approval of the German Stroke Registry (GSR) steering committee.

基线 NIHSS 值较低的缺血性脑卒中患者再通路失败的预测因素
背景:目前尚无随机对照证据表明,对于大血管闭塞但有轻微卒中症状(美国国立卫生研究院卒中量表[NIHSS] 6)的患者,机械取栓术(MT)优于最佳药物治疗,尽管成功再通畅,但仍有高达50%的病例观察到不利的功能结果,通常称为徒劳再通畅(FR):我们的多中心队列研究筛选了 2015 年至 2021 年期间前瞻性加入德国卒中注册血管内治疗的所有患者(n=13082)。研究对象包括因前循环血管闭塞而接受MT治疗且基线NIHSS评分达到结果的患者:共有 674 名患者符合纳入标准。268例(40%)患者发生了FR。多变量逻辑回归分析表明,年龄越大(调整赔率:1.04 [95% 置信区间:1.02-1.06])、卒中前 mRS 1(aOR:2.70 [1.51-4.84])、从入院医院转至综合卒中中心(aOR:1.67 [1.08-2.56])、从症状发作/最后一次见好到入院的时间较长(aOR:1.02 [1.00-1.04])、全身麻醉下 MT(aOR:1.78 [1.13-2.82])、24 小时后 NIHSS 较高(aOR:1.09 [1.05-1.14])以及无症状颅内出血(aOR:16.88 [2.03-140.14])均会增加 FR 的几率。达到 mTICI 2b 或 3 的主要结果没有明显差异:入院时 NIHSS 评分较低的急性缺血性卒中患者尽管血管再通成功,但仍经常出现不利的功能预后。我们提供了患者的特异性风险因素,这些因素表明 FR 风险增加,在治疗轻微卒中患者时应加以考虑:经 GSR 指导委员会批准后,如有合理要求,可提供支持我们研究结果的数据。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
International Journal of Stroke
International Journal of Stroke 医学-外周血管病
CiteScore
13.90
自引率
6.00%
发文量
132
审稿时长
6-12 weeks
期刊介绍: The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信