Abstract Details

Title Futility in Survival: Predictors of 90-Day Poor Outcomes (mRS 4-5) After Endovascular Thrombectomy for Ischemic Stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P1 - Poster Session 1 (11:45 AM-12:45 PM)

Poster/Presentation
Number 13-012

Objective

To determine whether baseline and procedure characteristics can predict major disability in stroke survivors following endovascular thrombectomy (EVT).

Background Stroke survivors face substantial hurdles in achieving favorable outcome (Modified Rankin Scale [mRS] 0-3) within 90 days. While the mortality rate for stroke is around 25%, non-mortal futility (mRS 4-5) remains a particularly severe outcome. This condition imposes a significant burden on both the patients and the healthcare system.

Design/Methods We retrospectively analyzed patients who survive stroke following EVT. Functional outcomes were assessed using the mRS at 90 days; dichotomized into favorable (mRS 0-3) and unfavorable (mRS 4-5) outcomes. Baseline and procedure variables were compared between the groups using pairwise comparisons and multivariable logistic regression models to identify independent predictors.

Results Of the 643 patients analyzed, 506(78.7%) had favorable outcomes, and 137(21.3%) had unfavorable outcomes. Age (median[IQR] 68[57-77]years vs. 74[65 -81]years ,p<0.001), baseline NIHSS score (median [IQR] 15[10 – 19] vs. 17[14-21],p<0.001), baseline ASPECTS median [IQR] (9[8-10] vs 9[8-9],p<0.01), and last known well to arrival (LKWA) (median [IQR] 4.8h [2.8–11.03] vs 7.5h [3.4–13.7],p<0.01) were significantly higher in patients with unfavorable outcomes. In addition, prior histories of stroke and atrial fibrillation (14.0%vs.26.3%, p<0.01, 24.1%vs38.0%, p=0.002; respectively) were more prevalent in the group with unfavorable outcomes. Multivariable analysis confirmed that older age (aOR 1.04, 95% CI:1.02-1.06,p<0.001), prior history of stroke (aOR 2.18,95% CI:1.28-3.67,p=0.004), baseline NIHSS (aOR 1.07, 95% CI: 1.03-1.10,p=0.003), LKWA (aOR 1.01,95% CI:1.001-1.02, p=0.0003), higher number of passes (NP) (aOR 1.2, 95% CI:1.03–1.43,p=0.02), and lack of successful recanalization (TICI 2b-3, aOR 0.24, 95% CI:0.1–0.6,p=0.003) were independent predictors of non-mortal futility.

Conclusions Non-mortal futility in EVT for was linked to older age, prior history of stroke or atrial fibrillation, higher baseline NIHSS score, prolonged LKWA time, failure to achieving successful recanalization, and higher NP.

Authors/Disclosures
Abdullah M. Al-Qudah, MD (University of Pittsburgh Medical Center) PRESENTER	Dr. Al-Qudah has nothing to disclose.
Mohamed Fahmy Doheim (University of Pittsburgh)	Mr. Doheim has nothing to disclose.
Lucas Rios Rocha, MD (UPMC)	Dr. Rios Rocha has nothing to disclose.
Anmol Almast	Miss Almast has nothing to disclose.
Nirav Bhatt, MD (University of Pittsburgh)	Dr. Bhatt has nothing to disclose.
Marcelo Rocha, MD, PhD (UPMC)	The institution of Dr. Rocha has received research support from NIH.
Matthew T. Starr, MD (University of Pittsburgh Medical Center)	Dr. Starr has nothing to disclose.
Jussie Correia Lima, MD	Dr. Correia Lima has nothing to disclose.
Michael Lang, MD	Dr. Lang has nothing to disclose.
Bradley Gross, MD	Dr. Gross has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Medtronic. Dr. Gross has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Microvention. Dr. Gross has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AHA.
Raul G. Nogueira, MD (UPMC Stroke Institute)	Dr. Nogueira has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for for advisory roles with Anaconda, Biogen, Cerenovus, Genentech, Hybernia, Imperative Care, Medtronic, Phenox, Philips, Prolong Pharmaceuticals, Stryker Neurovascular, Shanghai Wallaby, and Synchron (consulting fees) as well as for advisory roles with Astrocyte, Brainomix, Cerebrotech, Ceretrieve, Corindus Vascular Robotics, Vesalio, Viz-AI, RapidPulse and Perfuze ( stock options). Dr. Nogueira has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Law Firms. Dr. Nogueira has received stock or an ownership interest from Viz-AI, Perfuze, Cerebrotech, Reist/Q'Apel Medical, Truvic, and Viseon. The institution of Dr. Nogueira has received research support from Cerenovus.
Alhamza Al-Bayati, MD (UPMC Stroke Institute)	Dr. Al-Bayati has nothing to disclose.

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