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Taufik H, Hager C, Blum F, Jazi EY, Habib P, Ridwan H, Ferreira de Pinho JDP, Wiesmann M, Reich A, Nikoubashman O, Hasan D. Unfavorable neurological long-term outcome despite eTICI 3 - What are the predictors? Clin Neurol Neurosurg 2024; 245:108501. [PMID: 39173492 DOI: 10.1016/j.clineuro.2024.108501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 07/10/2024] [Accepted: 08/05/2024] [Indexed: 08/24/2024]
Abstract
PURPOSE Interventional stroke therapy has become standard treatment for patients with acute ischemic strokes. Complete reperfusion (eTICI 3) portrays the best possible technical outcome. The purpose of this study was to determine possible predictors for an unfavorable neurological long-term outcome (mRS 3-6) despite achieving the best possible treatment success. METHODS We evaluated 122 patients with stroke in the anterior circulation and complete reperfusion after mechanical thrombectomy (MT) between May 2010 and March 2020. We performed a binary logistic regression analysis with patient baseline data, stroke severity, comorbidities, premedication and treatment information as independent variables. RESULTS 50 of the 122 patients included in our study showed a poor clinical outcome after 90 days (41 %). Multivariable logistic regression analysis showed that older age (p = 0.033), higher admission NIHSS (p=0.009), lower admission ASPECTS (p=0.005), a pre-existing cardiovascular disease (p=0.017), and multiple passes for complete reperfusion (p=0.030) had an independent impact on unfavorable outcome. CONCLUSIONS Older age, higher NIHSS upon admission, lower ASPECTS upon admission, cardiovascular comorbidities and multiple passes for complete reperfusion are predictors for poor neurological long-term outcome despite complete reperfusion.
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Affiliation(s)
- Homan Taufik
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Pauwelsstr. 30, Aachen 52074, Germany
| | - Charlotte Hager
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Pauwelsstr. 30, Aachen 52074, Germany
| | - Friederike Blum
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Pauwelsstr. 30, Aachen 52074, Germany
| | - Ehsan Yousefian Jazi
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Pauwelsstr. 30, Aachen 52074, Germany
| | - Pardes Habib
- Department of Neurology, University Hospital RWTH Aachen, Pauwelsstr. 30, Aachen 52074, Germany
| | - Hani Ridwan
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Pauwelsstr. 30, Aachen 52074, Germany
| | | | - Martin Wiesmann
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Pauwelsstr. 30, Aachen 52074, Germany
| | - Arno Reich
- Department of Neurology, University Hospital RWTH Aachen, Pauwelsstr. 30, Aachen 52074, Germany
| | - Omid Nikoubashman
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Pauwelsstr. 30, Aachen 52074, Germany
| | - Dimah Hasan
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Pauwelsstr. 30, Aachen 52074, Germany.
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Compagne KCJ, Kappelhof M, Hinsenveld WH, Brouwer J, Goldhoorn RJB, Uyttenboogaart M, Bokkers RPH, Schonewille WJ, Martens JM, Hofmeijer J, van der Worp HB, Lo RTH, Keizer K, Yo LSF, Lycklama À Nijeholt GJ, den Hertog HM, Sturm EJC, Brouwers PJAM, van Walderveen MAA, Wermer MJH, de Bruijn SF, van Dijk LC, Boogaarts HD, van Dijk EJ, van Tuijl JH, Peluso JPP, de Kort PLM, van Hasselt BAAM, Fransen PS, Schreuder THCML, Heijboer RJJ, Jenniskens SFM, Sprengers MES, Ghariq E, van den Wijngaard IR, Roosendaal SD, Meijer AFJA, Beenen LFM, Postma AA, van den Berg R, Yoo AJ, van Doormaal PJ, van Proosdij MP, Krietemeijer MGM, Gerrits DG, Hammer S, Vos JA, Boiten J, Coutinho JM, Emmer BJ, van Es ACGM, Roozenbeek B, Roos YBWEM, van Zwam WH, van Oostenbrugge RJ, Majoie CBLM, Dippel DWJ, van der Lugt A. Improvements in Endovascular Treatment for Acute Ischemic Stroke: A Longitudinal Study in the MR CLEAN Registry. Stroke 2022; 53:1863-1872. [PMID: 35135323 PMCID: PMC9126265 DOI: 10.1161/strokeaha.121.034919] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We evaluated data from all patients in the Netherlands who underwent endovascular treatment for acute ischemic stroke in the past 3.5 years, to identify nationwide trends in time to treatment and procedural success, and assess their effect on clinical outcomes.
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Affiliation(s)
- Kars C J Compagne
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, the Netherlands. (K.C.J.C., P.J.v.D.).,Department of Neurology, Erasmus MC, University Medical Center' Rotterdam' the Netherlands. (K.C.J.C., B.R., D.W.J.D.)
| | - Manon Kappelhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam' the Netherlands. (M.K., M.E.S.S., S.D.R., L.F.M.B., R.v.d.B., B.J.E., C.B.L.M.M.)
| | - Wouter H Hinsenveld
- Department of Radiology and Nuclear Medicine, School for Cardiovascular Diseases (CARIM), School for Mental Health and Sciences, Maastricht University Medical Center' the Netherlands. (A.A.P., W.H.v.Z.)
| | - Josje Brouwer
- Department of Neurology, Amsterdam UMC, University of Amsterdam' the Netherlands. (J.B., J.M.C., Y.B.W.E.M.R.)
| | - Robert-Jan B Goldhoorn
- Department of Neurology, School for Cardiovascular Diseases (CARIM), School for Mental Health and Sciences, Maastricht University Medical Center' the Netherlands. (W.H.H., R.-J.B.G., R.J.v.O.)
| | | | - Reinoud P H Bokkers
- Department of Radiology, University Medical Center Groningen' the Netherlands. (R.P.H.B.)
| | | | - Jasper M Martens
- Department of Radiology, Rijnstate Hospital' Arnhem' the Netherlands. (J.M.M.)
| | - Jeannette Hofmeijer
- Department of Neurology, Rijnstate Hospital' Arnhem' the Netherlands. (J.H.)
| | - H Bart van der Worp
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht' the Netherlands. (H.B.v.d.W.)
| | - Rob T H Lo
- Department of Radiology, University Medical Center Utrecht' the Netherlands. (R.T.H.L.O.)
| | - Koos Keizer
- Department of Neurology, Catharina Hospital' Eindhoven' the Netherlands. (K.K.)
| | - Lonneke S F Yo
- Department of Radiology, Catharina Hospital' Eindhoven' the Netherlands. (L.S.F.Y., M.G.M.K.)
| | | | - Heleen M den Hertog
- Department of Neurology, Isala Klinieken' the Netherlands. (H.M.d.H., P.S.F.)
| | - Emiel J C Sturm
- Department of Radiology, Medical Spectrum Twente' the Netherlands. (E.J.C.S., D.G.G.)
| | - Paul J A M Brouwers
- Department of Neurology, Medical Spectrum Twente' the Netherlands. (P.J.A.M.B.)
| | | | - Marieke J H Wermer
- Department of Neurology, Leiden University Medical Center' the Netherlands. (M.J.H.W.)
| | | | - Lukas C van Dijk
- Department of Radiology, HAGA Hospital' the Netherlands. (L.C.v.D.)
| | - Hieronymus D Boogaarts
- Department of Neurosurgery, Radboud University Medical Center' the Netherlands. (H.D.B.)
| | - Ewout J van Dijk
- Department of Neurology, Radboud University Medical Center' the Netherlands. (E.J.v.D.)
| | | | - Jo P P Peluso
- Department of Radiology, Sint Elisabeth Hospital' the Netherlands. (J.P.P.)
| | - Paul L M de Kort
- Department of Neurology, Sint Elisabeth Hospital' the Netherlands. (P.L.M.d.K.)
| | | | - Puck S Fransen
- Department of Neurology, Isala Klinieken' the Netherlands. (H.M.d.H., P.S.F.)
| | | | | | - Sjoerd F M Jenniskens
- Department of Radiology, Radboud University Medical Center' the Netherlands. (S.F.M.J., A.F.J.A.M.)
| | - Marieke E S Sprengers
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam' the Netherlands. (M.K., M.E.S.S., S.D.R., L.F.M.B., R.v.d.B., B.J.E., C.B.L.M.M.)
| | - Elias Ghariq
- Department of Radiology, Haaglanden Medical Center' the Netherlands. (G.J.L.à.N., E.G.)
| | | | - Stefan D Roosendaal
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam' the Netherlands. (M.K., M.E.S.S., S.D.R., L.F.M.B., R.v.d.B., B.J.E., C.B.L.M.M.)
| | - Anton F J A Meijer
- Department of Radiology, Radboud University Medical Center' the Netherlands. (S.F.M.J., A.F.J.A.M.)
| | - Ludo F M Beenen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam' the Netherlands. (M.K., M.E.S.S., S.D.R., L.F.M.B., R.v.d.B., B.J.E., C.B.L.M.M.)
| | - Alida A Postma
- Department of Radiology and Nuclear Medicine, School for Cardiovascular Diseases (CARIM), School for Mental Health and Sciences, Maastricht University Medical Center' the Netherlands. (A.A.P., W.H.v.Z.)
| | - René van den Berg
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam' the Netherlands. (M.K., M.E.S.S., S.D.R., L.F.M.B., R.v.d.B., B.J.E., C.B.L.M.M.)
| | - Albert J Yoo
- Department of Radiology, Texas Stroke Institute' Plano' TX (A.J.Y.)
| | - Pieter Jan van Doormaal
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, the Netherlands. (K.C.J.C., P.J.v.D.)
| | - Marc P van Proosdij
- Department of Radiology, Noordwest Ziekenhuisgroep' the Netherlands (M.P.v.P.)
| | - Menno G M Krietemeijer
- Department of Radiology, Catharina Hospital' Eindhoven' the Netherlands. (L.S.F.Y., M.G.M.K.)
| | - Dick G Gerrits
- Department of Radiology, Medical Spectrum Twente' the Netherlands. (E.J.C.S., D.G.G.)
| | | | - Jan Albert Vos
- Department of Radiology, Sint Antonius Hospital' the Netherlands. (J.A.V.)
| | - Jelis Boiten
- Department of Neurology, Haaglanden Medical Center' the Netherlands. (I.R.v.d.W., J.B.)
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam UMC, University of Amsterdam' the Netherlands. (J.B., J.M.C., Y.B.W.E.M.R.)
| | - Bart J Emmer
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam' the Netherlands. (M.K., M.E.S.S., S.D.R., L.F.M.B., R.v.d.B., B.J.E., C.B.L.M.M.)
| | - Ad C G M van Es
- Department of Radiology, Leiden University Medical Center' the Netherlands. (M.A.A.v.W., A.C.G.M.v.E.)
| | - Bob Roozenbeek
- Department of Neurology, Erasmus MC, University Medical Center' Rotterdam' the Netherlands. (K.C.J.C., B.R., D.W.J.D.)
| | - Yvo B W E M Roos
- Department of Neurology, Amsterdam UMC, University of Amsterdam' the Netherlands. (J.B., J.M.C., Y.B.W.E.M.R.)
| | - Wim H van Zwam
- Department of Neurology, School for Cardiovascular Diseases (CARIM), School for Mental Health and Sciences, Maastricht University Medical Center' the Netherlands. (W.H.H., R.-J.B.G., R.J.v.O.)
| | - Robert J van Oostenbrugge
- Department of Neurology, School for Cardiovascular Diseases (CARIM), School for Mental Health and Sciences, Maastricht University Medical Center' the Netherlands. (W.H.H., R.-J.B.G., R.J.v.O.)
| | - Charles B L M Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam' the Netherlands. (M.K., M.E.S.S., S.D.R., L.F.M.B., R.v.d.B., B.J.E., C.B.L.M.M.)
| | - Diederik W J Dippel
- Department of Neurology, Erasmus MC, University Medical Center' Rotterdam' the Netherlands. (K.C.J.C., B.R., D.W.J.D.)
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