Clinical Predictors for Functional Independence After Tissue-Window Guided Endovascular Thrombectomy

Area of Science:

• Neurology
• Interventional Cardiology
• Stroke Medicine

Background:

• Endovascular thrombectomy significantly improves survival rates for acute ischemic stroke patients with large vessel occlusion.
• Identifying predictors for successful outcomes is crucial for optimizing patient selection and treatment strategies in stroke care.

Purpose of the Study:

• To determine clinical predictors associated with favorable outcomes in patients undergoing tissue-window guided thrombectomy for acute ischemic stroke.
• To establish optimal cutoff values for key clinical and imaging parameters predicting functional independence post-thrombectomy.

Main Methods:

• Retrospective analysis of baseline characteristics and 90-day outcomes in 47 patients who underwent endovascular thrombectomy within 6-24 hours of last known well time.
• Binary logistic regression was employed to identify independent clinical predictors of functional independence.
• Receiver operator characteristic (ROC) curve analysis was used to determine optimal cutoff values for predictors.

Main Results:

• Multivariate regression identified lower initial National Institutes of Health Stroke Scale (NIHSS) score, smaller ischemic penumbra volume, and absence of hemorrhagic transformation as significant predictors of good outcomes.
• Optimal thresholds for prediction were determined: NIHSS score ≤14.5 (AUC: 0.867), ischemic penumbra ≤109 mL (AUC: 0.841), and infarct core ≤12.5 mL (AUC: 0.681).
• The study included diverse stroke onset types: last-presenting (27.7%), wake-up (51.1%), and unknown onset (21.3%).

Conclusions:

• Lower initial NIHSS scores, smaller ischemic penumbra, and the absence of hemorrhagic transformation are key independent predictors for good outcomes following tissue-window based thrombectomy.
• These findings can guide clinical decision-making in the acute management of large vessel occlusion strokes.