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Clinical and radiological factors predicting stroke outcome after successful mechanical intervention in anterior
Tomáš Peisker1, Peter Vaško1, Petr Mikulenka1
1Department of Neurology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Šrobárova 50, 100 34 Praha, Prague, Czech Republic.
Insights
Good leptomeningeal collaterals and absence of leukoaraiosis predict favorable outcomes after stroke recanalization. Late thrombectomy showed poorer results, highlighting collateral status as a key selection factor.
Area of Science:
- Neurology
- Interventional Radiology
- Stroke Medicine
Background:
- Large-vessel occlusion (LVO) in the anterior circulation is a significant cause of stroke.
- While endovascular treatment offers recanalization, patient outcomes vary significantly.
- Identifying factors predicting successful treatment is crucial for optimizing patient selection.
Purpose of the Study:
- To analyze clinical and radiological factors influencing outcomes after successful mechanical recanalization for anterior circulation LVO.
- To identify independent predictors of good clinical outcome in patients undergoing endovascular treatment.
Main Methods:
- Retrospective analysis of 146 patients from the Prague 16 study (2012-2020) with successful recanalization (TICI 2b-3).
- Clinical data and initial CT/CTA imaging were assessed.
- Univariate and multivariate regression analyses were performed to identify outcome determinants.
Main Results:
- 73% of patients achieved a good clinical outcome (mRS 0-2 at 3 months).
- Independent predictors of good outcome included good leptomeningeal collaterals (LC), higher ASPECTS, and lower NIHSS score.
- Leukoaraiosis (LA) and late thrombectomy were associated with unfavorable outcomes.
Conclusions:
- Good collateral status and absence of leukoaraiosis are key predictors of favorable outcomes in acute stroke patients with successfully recanalized LVO.
- While late thrombectomy may lead to poorer outcomes, collateral status remains a reliable selection criterion.
- These findings can help refine patient selection for endovascular stroke treatment.
Abstract:
The recanalization effect of large-vessel occlusion (LVO) in anterior circulation is well documented but only some patients benefit from endovascular treatment. We analysed clinical and radiological factors determining clinical outcome after successful mechanical intervention. We included 146 patients from the Prague 16 study enrolled from September 2012 to December 2020, who had initial CT/CTA examination and achieved good recanalization status after mechanical intervention (TICI 2b-3). One hundred and six (73%) patients achieved a good clinical outcome (modified Rankin Scale 0-2 in 3 months). It was associated with age, leptomeningeal collaterals (LC), onset to intervention time, ASPECTS, initial NIHSS, and leukoaraiosis (LA) in univariate analysis. The regression model identified good collateral status [odds ratio (OR) 5.00, 95% confidence interval (CI) 1.91-13.08], late thrombectomy (OR 0.24, 95% CI 0.09-0.65), LA (OR 0.44, 95% CI 0.19-1.00), ASPECTS (OR 1.45, 95% CI 1.08-1.95), and NIHSS score (OR 0.86, 95% CI 0.78-0.95) as independent outcome determinants. In the late thrombectomy subgroup, 14 out of 33 patients (42%) achieved a favourable clinical outcome, none of whom with poor collateral status. The presence of LC and absence of LA predicts a good outcome in acute stroke patients after successful recanalization of LVO in anterior circulation. Late thrombectomy was associated with higher rate of unfavourable clinical outcome. Nevertheless, collateral status in this subgroup was validated as a reliable selection criterion.
