Dataset Information

Predicting mortality in acute ischaemic stroke treated with mechanical thrombectomy: analysis of a multicentre prospective registry.

ABSTRACT:

Objectives

We aimed to determine predictors of mortality within 90 days and develop a simple score for patients with mechanical thrombectomy (MT).

Design

Analysis of a multicentre prospective registry.

Setting

In six participating centres, patients who had an acute ischaemic stroke (AIS) treated by MT between March 2017 and May 2018 were documented prospectively.

Participants

224 patients with AIS were treated by MT.

Results

Of 224 patients, 49 (21.9%) patients died, and 87 (38.8%) were independent. Variables associated with 90-day mortality were age, previous stroke, admission National Institutes of Health Stroke Scale (NIHSS), fasting blood glucose and occlusion site. Logistic regression identified four variables independently associated with 90-day mortality: age ≥80 years (OR 3.26, 95% CI 1.45 to 7.33), previous stroke (OR 2.33, 95% CI 1.04 to 5.21), admission NIHSS ≥18 (OR 2.37, 95% CI 1.13 to 4.99) and internal carotid artery or basilar artery occlusion (OR 2.92, 95% CI 1.34 to 6.40). Using these data, we developed predicting 90-day mortality of AIS with MT (PRACTICE) score ranging from 0 to 6 points. The receiver operator curve analysis found that PRACTICE score (area under the curve (AUC)=0.744, 95% CI 0.669 to 0.820) was numerically better than iScore (AUC=0.661, 95% CI 0.577 to 0.745) and Predicting Early Mortality of Ischemic Stroke score (AUC=0.638, 95% CI 0.551 to 0.725) for predicting 90-day mortality.

Conclusions

We developed a simple score to estimate the 90-day mortality of patients who had an AIS treated with MT. But the score needs to be prospectively validated.

Trial registration number

Chinese Clinical Trial Registry (ChiCTR-OOC-17013052).

SUBMITTER: Li H

PROVIDER: S-EPMC8021751 | biostudies-literature | 2021 Apr

REPOSITORIES: biostudies-literature

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Publications

Predicting mortality in acute ischaemic stroke treated with mechanical thrombectomy: analysis of a multicentre prospective registry.

Li Hao H Ye Shi-Sheng SS Wu Yuan-Ling YL Huang Sheng-Ming SM Li Yong-Xin YX Lu Kui K Huang Jing-Bo JB Chen Lve L Li Hong-Zhuang HZ Wu Wen-Jun WJ Wu Zhi-Lin ZL Wu Jian-Zhou JZ Zhong Wang-Tao WT Xian Wen-Chuan WC Liao Feng F Tung Tao-Hsin TH Wu Qiao-Ling QL Chen Hai H Yuan Li L Yang Zhi Z Huang Li-An LA

BMJ open 20210401 4

<h4>Objectives</h4>We aimed to determine predictors of mortality within 90 days and develop a simple score for patients with mechanical thrombectomy (MT).<h4>Design</h4>Analysis of a multicentre prospective registry.<h4>Setting</h4>In six participating centres, patients who had an acute ischaemic stroke (AIS) treated by MT between March 2017 and May 2018 were documented prospectively.<h4>Participants</h4>224 patients with AIS were treated by MT.<h4>Results</h4>Of 224 patients, 49 (21.9%) patient ...[more]

PMID: 33795300

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Project description:Background and purposeRescue therapies are increasingly used in the setting of endovascular therapy for large-vessel occlusion strokes. Among these, cangrelor, a new P2Y12 inhibitor, offers promising pharmacologic properties to join the reperfusion strategies in acute stroke. We assessed the safety and efficacy profiles of cangrelor combined with endovascular therapy in patients with large-vessel-occlusion stroke.Materials and methodsWe performed a retrospective patient data analysis in the ongoing prospective multicenter observational Endovascular Treatment in Ischemic Stroke Registry in France from July 2018 to December 2020 and conducted a systematic review and meta-analysis using several data bases. Indications for cangrelor administration were rescue strategy in case of refractory intracranial occlusion with or without intracranial rescue stent placement, and cervical carotid artery stent placement in case of cervical occlusion (tandem occlusion or isolated cervical carotid occlusion).ResultsIn the clinical registry, 44 patients were included (median initial NIHSS score, 12; prior intravenous thrombolysis, 29.5%). Intracranial stent placement was performed in 54.5% (n = 24/44), and cervical stent placement, in 27.3% (n = 12/44). Adjunctive aspirin and heparin were administered in 75% (n = 33/44) and 40.9% (n = 18/44), respectively. Rates of symptomatic intracerebral hemorrhage, parenchymal hematoma, and 90-day mortality were 9.5% (n = 4/42), 9.5% (n = 4/42), and 24.4% (n = 10/41). Favorable outcome (90-day mRS, 0-2) was reached in 51.2% (n = 21/41), and successful reperfusion, in 90.9% (n = 40/44). The literature search identified 6 studies involving a total of 171 subjects. In the meta-analysis, including our series data, symptomatic intracerebral hemorrhage occurred in 8.6% of patients (95% CI, 5.0%-14.3%) and favorable outcome was reached in 47.6% of patients (95% CI, 27.4%-68.7%). The 90-day mortality rate was 22.6% (95% CI, 13.6%-35.2%). Day 1 artery patency was observed in 89.7% (95% CI, 81.4%-94.6%).ConclusionsCangrelor offers promising safety and efficacy profiles, especially considering the complex endovascular reperfusion procedures in which it is usually applied. Further large prospective data are required to confirm these findings.

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Dataset Information

Predicting mortality in acute ischaemic stroke treated with mechanical thrombectomy: analysis of a multicentre prospective registry.

Objectives

Design

Setting

Participants

Results

Conclusions

Trial registration number

Publications

Predicting mortality in acute ischaemic stroke treated with mechanical thrombectomy: analysis of a multicentre prospective registry.

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