Abstract
Background and purpose: Mechanical thrombectomy (MT) improves early clinical outcome in patients with acute ischemic stroke but insights on determinants of long-term outcome after MT treatment are scarce. Methods: Data from stroke patients with anterior circulation large vessel occlusion of a prospective MT registry (01/2014–06/2017) of a large comprehensive stroke center were analyzed regarding clinical outcome between short- (3 months) and long-term (12 months) assessment reflected by a change of modified Rankin scores (∆mRS). Secondary endpoints included favorable long-term outcome (mRS 0–2). Multi-variable regression analysis was performed to identify determinants of outcome changes and favorable outcome at long term. Results: Of 264 patients included, 42.0% showed a favorable long-term outcome. Longitudinal analysis found that some individuals still improved, but no overall mRS difference between short and long-term follow-up was detected [∆mRS − 0.004 (95% CI − 0.020; 0.013); p = 0.672]. Right hemispheric stroke [∆mRS 0.286 (0.011; 0.561); p = 0.043] and high NIHSS at discharge [∆mRS, 0.039 (0.004; 0.074); p = 0.029] were associated with a longitudinal mRS decline. Favorable long-term outcome was associated with successful recanalization (p < 0.0001). Conclusions: A significant number of patients with MT experience a favorable long-term outcome. Outcomes remained stable between short- and long-term follow-up, but some individuals may still show improvement beyond short-term rehabilitation. Right hemispheric stroke and clinical stroke severity at hospital discharge may be frail predictors for delayed decline of functional status, whereas successful recanalization remains a positive outcome predictor. Death rarely occurs beyond 3 months after MT treatment.
| Original language | English |
|---|---|
| Journal | Journal of Neurology |
| Volume | 267 |
| Issue number | 4 |
| Pages (from-to) | 1026-1034 |
| Number of pages | 9 |
| ISSN | 0340-5354 |
| DOIs | |
| Publication status | Published - 01.04.2020 |
Funding
Dr. Fuhrer has nothing to disclose. Dr. Forner has nothing to disclose. Mr. Pruellage has nothing to disclose. Dr. Schacht has nothing to disclose. Ms. Weber has nothing to disclose. Dr. Beume has nothing to disclose. Prof. Bardutzky reports speaking honoraria from Bayer Health Care, Boehringer Ingelheim, Daiichi Sankyo and Pfizerm, outside the submitted work. Prof. Weiller has nothing to disclose. Dr. Egger is shareholder of the VeoBrain GmbH and reports honoraria payments for specific speeches and seminar presentations from Stryker, outside the submitted work. Prof. Urbach is shareholder of the VeoBrain GmbH, outside the submitted work. Dr. Niesen has nothing to disclose. Prof. Meckel reports consultant fees for membership of the scientific advisory board of Acandis; speaker honorarium (modest), travel grant, video case support (non-financial) from Medtronic; travel grants from Microvention; Stryker; research grant (money paid to institution) from Bracco S.p.A; consultant fee from Novartis Pharma GmbH, all outside the submitted work.
