Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Predictors of Good Outcomes in Patients with Failed Endovascular Thrombectomy

  • Hyungjong Park (Department of Radiology, Severance Hospital Stroke Center, Yonsei University College of Medicine) ;
  • Byung Moon Kim (Department of Radiology, Severance Hospital Stroke Center, Yonsei University College of Medicine) ;
  • Jang-Hyun Baek (Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Jun-Hwee Kim (Department of Radiology, Severance Hospital Stroke Center, Yonsei University College of Medicine) ;
  • Ji Hoe Heo (Department of Neurology, Severance Hospital Stroke Center, Yonsei University College of Medicine) ;
  • Dong Joon Kim (Department of Radiology, Severance Hospital Stroke Center, Yonsei University College of Medicine) ;
  • Hyo Suk Nam (Department of Neurology, Severance Hospital Stroke Center, Yonsei University College of Medicine) ;
  • Young Dae Kim (Department of Neurology, Severance Hospital Stroke Center, Yonsei University College of Medicine)
  • Received : 2019.08.06
  • Accepted : 2020.01.02
  • Published : 2020.05.01
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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.

Keywords

Acknowledgement

This work supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (HC15C1056).

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