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Predictors of Good Outcomes in Patients With Failed Endovascular Thrombectomy

Authors
 Hyungjong Park  ;  Byung Moon Kim  ;  Jang Hyun Baek  ;  Jun Hwee Kim  ;  Ji Hoe Heo  ;  Dong Joon Kim  ;  Hyo Suk Nam  ;  Young Dae Kim 
Citation
 KOREAN JOURNAL OF RADIOLOGY, Vol.21(5) : 582-587, 2020-05 
Journal Title
 KOREAN JOURNAL OF RADIOLOGY 
ISSN
 1229-6929 
Issue Date
2020-05
Keywords
Cerebral infarction ; Predictive factor ; Prognosis ; Thrombectomy
Abstract
Objective: Endovascular thrombectomy (EVT) fails in approximately 20% of anterior circulation large vessel occlusion (AC-LVO). Nonetheless, the factors that affect clinical outcomes of non-recanalized AC-LVO despite EVT are less studied. The purpose of this study was to identify the factors affecting clinical outcomes in non-recanalized AC-LVO patients despite EVT. Materials and methods: This was a retrospective analysis of clinical and imaging data from 136 consecutive patients who demonstrated recanalization failure (modified thrombolysis in cerebral ischemia [mTICI], 0-2a) despite EVT for AC-LVO. Data were collected in prospectively maintained registries at 16 stroke centers. Collateral status was categorized into good or poor based on the CT angiogram, and the mTICI was categorized as 0-1 or 2a on the final angiogram. Patients with good (modified Rankin Scale [mRS], 0-2) and poor outcomes (mRS, 3-6) were compared in multivariate analysis to evaluate the factors associated with a good outcome. Results: Thirty-five patients (25.7%) had good outcomes. The good outcome group was younger (odds ratio [OR], 0.962; 95% confidence interval [CI], 0.932-0.992; p = 0.015), had a lower incidence of hypertension (OR, 0.380; 95% CI, 0.173-0.839; p = 0.017) and distal internal carotid artery involvement (OR, 0.149; 95% CI, 0.043-0.520; p = 0.003), lower initial National Institute of Health Stroke Scale (NIHSS) (OR, 0.789; 95% CI, 0.713-0.873; p < 0.001) and good collateral status (OR, 13.818; 95% CI, 3.971-48.090; p < 0.001). In multivariate analysis, the initial NIHSS (OR, 0.760; 95% CI, 0.638-0.905; p = 0.002), good collateral status (OR, 14.130; 95% CI, 2.264-88.212; p = 0.005) and mTICI 2a recanalization (OR, 5.636; 95% CI, 1.216-26.119; p = 0.027) remained as independent factors with good outcome in non-recanalized patients. Conclusion: Baseline NIHSS score, good collateral status, and mTICI 2a recanalization remained independently associated with clinical outcome in non-recanalized patients. mTICI 2a recanalization would benefit patients with good collaterals in non-recanalized AC-LVO patients despite EVT.
Files in This Item:
T202001567.pdf Download
DOI
10.3348/kjr.2019.0578
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dong Joon(김동준) ORCID logo https://orcid.org/0000-0002-7035-087X
Kim, Byung Moon(김병문) ORCID logo https://orcid.org/0000-0001-8593-6841
Kim, Young Dae(김영대) ORCID logo https://orcid.org/0000-0001-5750-2616
Kim, Jun-Hwee(김준휘)
Nam, Hyo Suk(남효석) ORCID logo https://orcid.org/0000-0002-4415-3995
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/176180
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