Acute ischemic stroke patient factors associated with poor outcomes in patients with favorable collaterals and successful thrombectomy

Abstract

Objectives

Favorable arterial collaterals are correlated to favorable outcomes after endovascular thrombectomy (EVT), but many patients still have unfavorable outcomes despite favorable collaterals and successful reperfusion. We determined factors associated with favorable outcome in patients with good collaterals who had successful EVT.

Materials and methods

In a post hoc analysis of the prospective CRISP 2 study, we identified patients with good collaterals (Tan≥2) and successful reperfusion (TICI 2b-3). Favorable (mRS 0-2) and unfavorable outcome (mRS 3-6) groups were compared to identify clinical, imaging, and treatment predictors of favorable outcome.

Results

92 patients were included. 33.7 % had favorable outcomes. There were no differences in sex (52 % females versus 54 % females; p = 0.821) or age (71 years [IQR 56-79] versus 68 years [IQR 57-79]; p = 0.859) in favorable versus unfavorable groups, respectively. Favorable outcome patients had more frequent intravenous thrombolysis (52 % versus 23 %; p = 0.006), shorter EVT procedures (27 min [IQR 23-40] versus 46 min ([IQR 27-64], and lower baseline NIHSS (12 [IQR 9-15] versus 16 [IQR 12-20]; p = 0.006). There were no differences in the frequency of TICI 3 rates (48 % vs. 38 %; p = 0.325) or first pass effect between the two groups (61 % vs. 57 %; p = 0.719). In a multivariable regression analysis, pre-stroke mRS 1 versus 0 versus (OR 0.15 [95 % CI: 0.03-0.78]; p = 0.024), pre-stroke mRS ≥3 versus 0 (OR 0.04 [95 % CI: 0.002-0.94]; p = 0.046), intravenous thrombolysis administration (OR 3.27 [95 % CI: 1.04-10.33]; p = 0.043) and EVT procedure time (OR for every 5 min 0.98 [95 % CI: 0.81-0.98]; p = 0.022) were modifiable predictors of favorable outcomes.

Conclusions

Among patients with good collaterals and successful reperfusion following EVT, favorable outcomes were associated with lower baseline mRS, intravenous thrombolysis administration, and shorter EVT procedure times.