MedWire News: Recanalization status is the best predictor for clinical outcomes in patients with acute ischemic stroke undergoing thrombectomy, an analysis of clinical trial data indicates.
The study authors say their findings support the inclusion of internal carotid artery (ICA) occlusion as an endpoint in future clinical trials assessing the efficacy of mechanical clot removal.
In this study, which is published in the journal Stroke, Raul Nogueira (Massachusetts General Hospital, Boston, USA) and colleagues sought to identify predictors of clinical and angiographic outcomes in patients undergoing thrombectomy for proximal intracranial arterial occlusion.
They pooled data from Mechanical Embolus Removal in Cerebral Ischemia (MERCI) and Multi MERCI, both of which were prospective, multicenter trials assessing endovascular thrombectomy performed within 8 hours of stroke symptom onset. Data on 305 patients were included.
Multivariate analysis identified three factors as significant independent predictors for good outcomes: final revascularization status (odds ratio[OR]=20.4 for successful vs failed), baseline National Institutes of Health Stroke Scale (NIHSS) score (OR=0.86 for each 1-point increase), and age (OR=0.96 for each 1-year increase).
In addition, four factors were significant independent predictors for mortality at 90 days: final revascularization status (OR=0.28 for successful vs failed), baseline NIHSS score (OR=1.09 for each 1-point increase), age (OR=1.05), and ICA occlusion (OR=2.17 vs no occlusion).
For the endpoint of revascularization, systolic blood pressure on admission (OR=0.42 for <150 vs ≥150 mmHg) and M2 segment occlusion (OR=3.86 vs no occlusion) were significant independent predictors.
The authors suggest that the ability to remove the clot may be negatively influenced by systolic blood pressure on presentation “because of the hydraulic forces imposed by higher blood pressures.”
“Final recanalization status represents the strongest predictor for clinical outcomes in patients undergoing thrombectomy,” Nogueira and team conclude.
They add: “Although ICA occlusions are associated with increased rates of mortality, they do not appear to decrease the chances of good outcomes after thrombectomy. This finding supports the rationale of including ICA occlusions in future efficacy trials.”
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