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Updated: Jul 23, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Real world data in mechanical thrombectomy: who are we losing to follow-up?
Marianne Hahn1, Sonja Gröschel1, Ahmed Othman2
1Department of Neurology and Focus Program Translational Neuroscience (FTN), Rhine main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
Background:
Missing outcome data (MOD) is a common problem in clinical trials and registries, and a potential bias when drawing conclusions from these data. Identifying factors associated with MOD may help to increase follow-up rates and assess the need for imputation strategies. We investigated MOD in a multicenter, prospective registry study of mechanical thrombectomy (MT) in large vessel occlusion ischemic stroke.
Methods:
13 082 patients enrolled in the German Stroke Registry-Endovascular Treatment from May 2015 to December 2021 were analyzed with regard to MOD (90 day modified Rankin Scale, mRS). Univariate logistic regression analyses identified factors unbalanced between patients with and without MOD. Subgroup analyses were performed to identify patients for whom increased efforts to perform clinical follow-up after hospital discharge are needed.
Results:
We identified 19.7% (2580/13 082) of patients with MOD at the 90 day follow-up. MOD was more common with higher pre-stroke disability (mRS 3-5, 32.2% vs mRS 0-2, 13.7%; P<0.001), absence of bridging intravenous thrombolysis, longer time to treatment, and in patients with high post-stroke disability at discharge (mRS 3-5 vs 0-2: OR 1.234 (95% CI 1.107 to 1.375); P<0.001). In contrast, MOD was less common with futile recanalization (thrombolysis in cerebral infarction (TICI) score of 0-2a, 12.4% vs TICI 2b-3, 15.0%; P=0.001). In patients discharged alive with well documented baseline characteristics, shorter hospital stay (OR 0.992 (95% CI 0.985 to 0.998); P=0.010) and discharge to institutional care or hospital (OR 1.754 (95% CI 1.558 to 1.976); P<0.001) were associated with MOD.
Conclusion:
MOD in routine care MT registry data was not random. Increased efforts to perform clinical follow-up are needed, especially in the case of higher pre-stroke and post-stroke disability and discharge to hospital or institutional care.
Trial Registration:
NCT03356392.
Insights
Missing outcome data in mechanical thrombectomy registries is not random. Higher pre-stroke and post-stroke disability, and discharge to institutional care are associated with missing data, requiring targeted follow-up efforts.
Area of Science:
- Neurology
- Clinical Trials
- Data Science
Background:
- Missing outcome data (MOD) is a significant challenge in clinical trials and registries, potentially introducing bias.
- Identifying factors associated with MOD is crucial for improving follow-up rates and assessing imputation needs.
- This study investigated MOD in a large, multicenter registry of mechanical thrombectomy (MT) for large vessel occlusion ischemic stroke.
Purpose of the Study:
- To identify factors associated with missing outcome data (MOD) in patients undergoing mechanical thrombectomy (MT).
- To determine patient subgroups requiring increased follow-up efforts to mitigate potential bias in registry data.
- To analyze the impact of pre-stroke disability, treatment characteristics, and discharge disposition on MOD.
Main Methods:
- Analysis of 13,082 patients from the German Stroke Registry-Endovascular Treatment (May 2015 - Dec 2021).
- Assessment of 90-day modified Rankin Scale (mRS) for MOD.
- Univariate logistic regression and subgroup analyses to identify factors associated with MOD.
Main Results:
- 19.7% of patients had MOD at 90 days.
- MOD was significantly associated with higher pre-stroke disability (mRS 3-5), absence of bridging IV thrombolysis, and longer time to treatment.
- Higher post-stroke disability at discharge and discharge to institutional care were also linked to MOD, while futile recanalization showed less MOD.
Conclusions:
- Missing outcome data in mechanical thrombectomy registries is not random.
- Increased follow-up efforts are essential for patients with higher pre-stroke and post-stroke disability.
- Targeted strategies are needed for patients discharged to hospital or institutional care to reduce bias from MOD.
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