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Title: Prognostic factors in patients with acute ischemic stroke treated with mechanical thrombectomy
Abstract:
The aim of the first study was to determine the association between the time elapsed between stroke onset and groin puncture and the rate of recanalization as measured by the Thrombolysis in Cerebral Infarction (TICI) scale. This study was performed in the Comprehensive Stroke Centre in Krakow. The study included two hundred twenty-three patients with anterior circulation stroke (median age: 66 years; 48.4% female). We collected the following data for this study: demographics, stroke risk factors, transportation (directly from home or via another hospital), admission NIHSS, intravenous rt-Pa administration prior to MT, the number of passes used during MT, and the time elapsed between stroke onset and groin puncture. The favourable outcome measure was defined as a Thrombolysis in Cerebral Infarction (TICI) scale 2b or 3. The median time elapsed between stroke onset and groin puncture was 240 minutes. Grade 2b or 3 TICI scores were obtained in 70.4% of patients. Univariate logistic regression showed that among all studied parameters, only NIHSS affected the rate of recanalization, but in the multivariate logistic regression model, the only parameter that affected the rate of recanalization was the SO-GP time (OR:0.76, 95%CI:0.60-0.98, p=0.03). Results of the study suggest that the time elapsed between stroke onset and groin puncture affects the rate of recanalization in patients ; with MT. The aim of the second study was to determine the relationship between the use of anticoagulants in patients with ischemic stroke treated with mechanical thrombectomy and long-term functional outcome or mortality in the 90th day after onset. This study included 291 patients with acute ischemic stroke (median age: 66, 49% female). Thirty-seven patients (13%) were on therapeutic anticoagulation during mechanical thrombectomy. Data describing demographics, stroke risk factors, NIHSS on admission, postprocedural thrombolysis in cerebral infarction score, 24-hour postprocedural haemorrhagic transformation (ECASS-2) as seen on computed tomography and time between stroke onset and groin puncture were collected. The outcome measure was the modified Rankin Scale on day 90th after stroke onset. A favourable outcome was defined as a modified Rankin Scale not exceeding 2 points, and an unfavourable outcome was death. Univariate analysis showed that anticoagulated patients were older and more likely to have been diagnosed with hypertension, ischemic heart disease or atrial fibrillation. The patient groups did not differ in terms of clot location, postprocedural thrombolysis in cerebral infarction score, haemorrhagic transformation on computed tomography, or modified Rankin Score on day 90. Multivariate logistic regression analysis showed that younger age, male sex, no history of dia ; betes mellitus, lower NIHSS on admission, a shorter time between stroke onset and groin puncture and better recanalization were associated with favourable outcomes at day 90, and that therapeutic anticoagulation was not (OR: 1.28, 95%CI:0.56-2.92, p=0.55). The study showed that in anticoagulated patients with acute ischemic stroke, mechanical thrombectomy does not affect long-term outcomes. The aim of the third study was to examine the impact of an infection that requires antibiotic treatment (IRAT) after an acute ischemic stroke treated with mechanical thrombectomy on the functional outcome as well as mortality in 90. day. We included 291 patients with acute ischemic stroke treated with mechanical thrombectomy; in 184 (63.2%) patients, mechanical thrombectomy was preceded by intravenous thrombolysis, and 83 (28.5%) patients developed an infection that requires antibiotic treatment. The outcome measures were the modified Rankin Scale and mortality on day 90. A favourable outcome was defined as a modified Rankin Scale score ≤2. Multivariate analysis after adjustment for demographics, risk factors, NIHSS score upon admission and 24 hours later (delta NIHSS), haemorrhagic transformation on computed tomography and several clinical and biochemical markers, we showed that male sex and haemorrhagic transformation on CT scans taken 24 hours after stroke increased the risk of infection ; that requires treatment. Younger age, male sex, lower delta NIHSS, shorter time from stroke onset to groin puncture, better recanalization and lack of haemorrhagic transformation on CT scans taken 24 hours after stroke favourably affected outcome at day 90. In addition, older age, higher delta NIHSS, unknown stroke etiology, and lack of treatment with intravenous thrombolysis were independent predictors of death up to day 90. Infection that required antibiotic treatment did not enter the models for the studied outcome measures. Results of the study suggest that in acute ischemic stroke patients treated with mechanical thrombectomy, an infection that requires antibiotic treatment is not an independent factor that affects a favourable outcome or mortality 90 days after stroke.
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Rada Dyscypliny Nauki medyczne
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Last modified:
Nov 29, 2024
In our library since:
Oct 8, 2024
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5
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http://dl.cm-uj.krakow.pl:8080/publication/5162
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| Edition name | Date |
|---|---|
| ZB-140347 | Nov 29, 2024 |
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