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Published on: February 22, 2020
Predictors of outcomes following catheter-based therapy for acute stroke
Nay Htyte1, Parham Parto, Shawn Ragbir
1Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana.
Insights
Successful catheter-based therapy (CBT) improves outcomes for acute ischemic stroke (AIS) patients ineligible for IV-tPA. Younger patients and successful reperfusion significantly predict better neurologic outcomes, while older age increases mortality risk.
Area of Science:
- Neurology
- Interventional Cardiology
- Vascular Surgery
Background:
- Timely reperfusion is critical for favorable neurologic outcomes in acute ischemic stroke (AIS).
- Many AIS patients present outside the window for intravenous thrombolysis (IV-tPA).
- Catheter-based therapy (CBT) is an alternative for these patients, but outcome predictors require further understanding.
Purpose of the Study:
- To evaluate variables predicting good neurologic outcomes in AIS patients undergoing CBT.
- To compare outcomes between Interventional Cardiologists (IC) and Neurointerventionalists (NI) in performing CBT.
- To assess the impact of age and reperfusion success on patient outcomes.
Main Methods:
- Retrospective analysis of 124 consecutive AIS patients treated with CBT (2006-2012).
- Primary outcome: modified Rankin score (mRs) ≤2 at 90 days.
- Secondary outcomes: mortality at 30 days and 1 year; comparison of outcomes based on age, reperfusion (TICI ≥2), and operator specialty (IC vs. NI).
Main Results:
- Good neurologic outcome (mRs ≤2) was achieved in 64% of patients ≤65 years vs. 36% in those >65 years (P=0.002).
- Successful reperfusion (TICI ≥2) was associated with better outcomes (57% vs. 17%, P<0.001) and lower 30-day mortality (20% vs. 54%, P<0.001).
- No significant difference in 90-day outcomes between IC and NI treated patients.
Conclusions:
- Successful revascularization via CBT significantly improves neurologic outcomes in selected AIS patients.
- Advanced age (>65 years) and comorbidities are associated with poorer outcomes.
- Interventional Cardiologists achieve comparable outcomes to Neurointerventionalists when participating in stroke teams.
Background:
Timely reperfusion directly impacts favorable neurologic outcomes in acute ischemic stroke (AIS) patients. Most strokes present outside the 3-4.5 h window for intravenous thrombolysis (IV-tPA). Catheter-based therapy (CBT) is commonly used in patients not eligible for timely IV-tPa, but variables that predict good neurologic outcomes are poorly understood.
Methods:
Results of 124 consecutive AIS patients who received CBT at Ochsner Medical Center from 2006 and 2012 are reported. A modified Rankin score (mRs) of ≤ 2 at 90 day post-CBT was used as the primary measurement of a good neurologic outcome. All-cause mortality during the index hospitalization, ≤30 days from treatment, and at 1 year were reported. Results are reported as those treated by Interventional Cardiologists (IC) or by Neurointerventionalists (NI).
Results:
The mean age was 65 ± 16 years of which 48% (n = 52) were male. The mean NIHSS was 15.0 ± 7.5. Thrombolysis in cerebral infarction (TICI) ≥2 flow was achieved in 80% (n = 100). Good neurologic outcome was observed in 64% (n = 37 of 58) of patients 65 years or younger while in those older than 65, only 36% (n = 24 of 66) had the same outcome (P = 0.002). Mortality at 30 days for the two age groups were 21% (n = 12) vs. 50% (n = 33) (P = <0.001) respectively. A good neurologic outcome at 90 days was seen in 57% of patients with restoration of TICI ≥ 2 flow compared to 17% with TICI < 2 flow (P = <0.001). Those with failed reperfusion (TICI<2 flow) had 30-day mortality rate of 54% (13 of 24) vs. 20% (19 of 97) in those with TICI ≥ 2 flow (P = <0.001). At 90 days, there was no significant differences in patient outcomes between IC (n = 58) and NI (n = 66) treated patients.
Conclusion:
Successful revascularization with CBT leads to a good neurologic outcome in selected stroke patients. Medical co-morbidities and increased age > 65 years contributed to poor outcomes. To support broadening the number of physicians qualified to perform catheter-based stroke interventions, this study demonstrates that IC participating on a stroke team achieve comparable outcomes to NI.
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