Acute ischemic stroke patient factors associated with poor outcomes in patients with favorable collaterals and successful thrombectomy

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2025-04-17 DOI:10.1016/j.jstrokecerebrovasdis.2025.108311

Jamie Kesten BA , Michael Mlynash MD, MS , Nicole Yuen MS , Pierre Seners MD, PhD , Anke Wouters MD , Maya Schwartz BS , Gregory W. Albers MD , Maarten G. Lansberg MD, PhD , Jeremy J. Heit MD, PhD

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引用次数: 0

Abstract

Objectives

Favorable arterial collaterals are correlated to favorable outcomes after endovascular thrombectomy (EVT), but many patients still have unfavorable outcomes despite favorable collaterals and successful reperfusion. We determined factors associated with favorable outcome in patients with good collaterals who had successful EVT.

Materials and methods

In a post hoc analysis of the prospective CRISP 2 study, we identified patients with good collaterals (Tan≥2) and successful reperfusion (TICI 2b-3). Favorable (mRS 0-2) and unfavorable outcome (mRS 3-6) groups were compared to identify clinical, imaging, and treatment predictors of favorable outcome.

Results

92 patients were included. 33.7 % had favorable outcomes. There were no differences in sex (52 % females versus 54 % females; p = 0.821) or age (71 years [IQR 56-79] versus 68 years [IQR 57-79]; p = 0.859) in favorable versus unfavorable groups, respectively. Favorable outcome patients had more frequent intravenous thrombolysis (52 % versus 23 %; p = 0.006), shorter EVT procedures (27 min [IQR 23-40] versus 46 min ([IQR 27-64], and lower baseline NIHSS (12 [IQR 9-15] versus 16 [IQR 12-20]; p = 0.006). There were no differences in the frequency of TICI 3 rates (48 % vs. 38 %; p = 0.325) or first pass effect between the two groups (61 % vs. 57 %; p = 0.719). In a multivariable regression analysis, pre-stroke mRS 1 versus 0 versus (OR 0.15 [95 % CI: 0.03-0.78]; p = 0.024), pre-stroke mRS ≥3 versus 0 (OR 0.04 [95 % CI: 0.002-0.94]; p = 0.046), intravenous thrombolysis administration (OR 3.27 [95 % CI: 1.04-10.33]; p = 0.043) and EVT procedure time (OR for every 5 min 0.98 [95 % CI: 0.81-0.98]; p = 0.022) were modifiable predictors of favorable outcomes.

Conclusions

Among patients with good collaterals and successful reperfusion following EVT, favorable outcomes were associated with lower baseline mRS, intravenous thrombolysis administration, and shorter EVT procedure times.

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急性缺血性脑卒中患者有利络和成功取栓患者预后不良的相关因素

目的血管内血栓切除术（EVT）后，有利的动脉侧支与良好的预后相关，但许多患者尽管有有利的侧支和成功的再灌注，但仍有不利的预后。我们确定了具有良好侧支的EVT成功患者预后良好的相关因素。材料和方法在前瞻性CRISP 2研究的事后分析中，我们确定了具有良好支脉（Tan≥2）和成功再灌注（TICI 2b-3）的患者。比较有利结果组（mRS 0-2）和不利结果组（mRS 3-6），以确定有利结果的临床、影像学和治疗预测因素。结果共纳入92例患者。33.7%的患者预后良好。性别上没有差异(52%的女性vs 54%的女性；p = 0.821)或年龄(71岁[IQR 56-79]对68岁[IQR 57-79]；P = 0.859)。结果良好的患者有更频繁的静脉溶栓(52%对23%；p = 0.006)，更短的EVT程序(27分钟[IQR 23-40] vs . 46分钟（[IQR 27-64]），更低的基线NIHSS (12 [IQR 9-15] vs . 16 [IQR 12-20]；P = 0.006)。两组间tici3发生率无差异(分别为48%对38%；P = 0.325)或首过效应(61% vs. 57%；P = 0.719)。在多变量回归分析中，卒中前mr1 vs .0 vs . (OR: 0.15 [95% CI: 0.03-0.78]；p = 0.024)，卒中前mRS≥3 vs 0 (OR 0.04 [95% CI: 0.002-0.94]；p = 0.046)，静脉溶栓给药(OR 3.27 [95% CI: 1.04-10.33]；p = 0.043)和EVT手术时间(OR为每5 min 0.98 [95% CI: 0.81-0.98]；P = 0.022)是有利结果的可修改预测因子。结论：在侧支良好且EVT后再灌注成功的患者中，较低的基线mRS、静脉溶栓治疗和较短的EVT手术时间与良好的预后相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.