Predictors of mortality in acute large ischemic stroke patients after endovascular thrombectomy

Endovascular thrombectomy (EVT) has been recommended as first-line therapy for patients with acute large-core ischemic stroke, yet the mortality remains high. We aimed to identify independent predictors of death within 90 days after EVT in this population.

This is a multicenter cohort study across 38 Chinese comprehensive stroke centers (November 2021-February 2023). Acute ischemic stroke patients with anterior circulation large vessel occlusion with ASPECTS ≤5, who underwent EVT were included. Independent mortality predictors of 90-day mortality were identified using multivariate logistic regression.

Among 490 eligible patients with large core infarct included in this analysis, 205 (41.8 %) died within 90 days. In multivariable analysis, advancing age (adjusted OR 1.04, 95% CI 1.02-1.06; p < 0.001), admission hyperglycemia (adjusted OR 1.22, 95% CI 1.12-1.33; p < 0.001), higher NIHSS score on admission (adjusted OR 1.10, 95% CI 1.04-1.15; p < 0.001), lower ASPECTS on admission (adjusted OR 0.74, 95% CI 0.64-0.86; p < 0.001), unsuccessful reperfusion (eTICI<2b; adjusted OR 0.78, 95% CI 0.67-0.91), lower mTICI grade (p = 0.002), and poor collateral status (ASITN/SIR grade ≤2; adjusted OR 0.61, 95% CI 0.47-0.78, p <0.001) were independently associated with an increased risk of death within 90 days. SICH (p = 0.012), herniation (p < 0.001) and craniectomy (p = 0.001) were identified as independent in-hospital clinical predictors of mortality.

In addition to non-modifiable factors (age and baseline stroke severity), admission hyperglycaemia, reperfusion success and collateral status are key modifiable predictors. Early intervention of cerebral edema and hemorrhagic complications may improve survival in this high-risk population.