Prognostic factors for outcomes after mechanical thrombectomy with solitaire stent

• Published in: Journal of neuroradiology Vol. 40; no. 4; pp. 252 - 259
• Main Authors: Raoult, Hélène, Eugène, François, Ferré, Jean-Christophe, Gentric, Jean-Christophe, Ronzière, Thomas, Stamm, Aymeric, Gauvrit, Jean-Yves
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01.10.2013; Elsevier Masson
• Subjects: Adult; Age Distribution; Aged; Aged, 80 and over; Brain Ischemia - diagnosis; Brain Ischemia - mortality; Brain Ischemia - surgery; Causality; Comorbidity; Female; France - epidemiology; Humans; Life Sciences; Magnetic Resonance Angiography - statistics & numerical data; Male; Mechanical Thrombolysis - mortality; Middle Aged; Neurons and Cognition; Prevalence; Prognosis; Prognostic factors; Radiology; Risk Factors; Sex Distribution; Stents - statistics & numerical data; Stroke; Stroke - diagnosis; Stroke - mortality; Stroke - surgery; Survival Analysis; Survival Rate; Thrombectomy; Treatment Outcome; Young Adult; France; NIHSS; Stroke; Thrombectomy; DWI; ASPECT; TICI; ACO; IV; PCO; Prognostic factors; ROC curves; mRS; Alberta stroke program early CT; posterior circulation occlusions; Receiver Operating Characteristic curves; modified Rankin Scale; intravenous; diffusion-weighted imaging; National Institutes of Health Stroke Scale; thrombolysis in cerebral infarction score; anterior circulation occlusions
• ISSN: 0150-9861
• DOI: 10.1016/j.neurad.2013.04.001

Endovascular mechanical thrombectomy is emerging as a promising therapeutic approach for acute ischemic stroke. This study was aimed at identifying factors influencing outcomes after thrombectomy with a Solitaire stent device. Forty-five consecutive patients treated with thrombectomy using Solitaire FR were retrospectively included. Clinical, imaging and logistic variables were analyzed. A multivariate logistic regression analysis was used to identify variables influencing clinical outcome, based on discharge NIHSS score change and mRS at 3 months. Patient mean age and initial NIHSS score was 58 years (range 24–88) and 17 (range 6–32), respectively. An MRI was performed for 80% of patients, showing severe DWI lesion for 28% of patients and associated FLAIR hyperintensity for 58% of patients. Mean time from symptom onset to recanalization was 299min for the 32 ACO and 473min for the 13 PCO. Angiographic efficacy (TICI 2b-3) was achieved for 93% of patients and good clinical outcomes at discharge and at 3 months (mRS≤2) were achieved for 49% and 58% of patients, respectively. Independent prognostic factors for predicting good clinical outcomes at discharge were a short time to recanalization and FLAIR negativity. At 3 months, they were a short time to recanalization and patient age. DWI lesion severity was an associated prognostic factor. Two main prognostic factors for predicting a good clinical outcome after thrombectomy at 3 months were short time from symptom onset to recanalization and patient age.