Abstract Details

Title Key Predictors of 90-Day Functional Outcome for Patients with Large Infarct Core Undergoing Endovascular Therapy in Real-world Practice

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S31 - Stroke Risk Factors, Outcomes, and Prevention (4:30 PM-4:42 PM)

Poster/Presentation
Number 006

Objective To evaluate the clinical and imaging variables that have the largest impact on 90-day modified Rankin Scale (mRS) outcome for patients with large infarct core (LIC) undergoing endovascular therapy (EVT).

Background

Recent randomized trials have shown that patients with LIC can benefit from EVT, however the key factors to predict long-term functional outcome remain unclear.

Design/Methods From a prospectively collected multicenter registry, consecutive patients undergoing EVT were identified with pre-treatment ASPECTS 0 to 5. The cohort was divided a priori into 80:20 training and testing sets for the final analysis. Multivariable logistic regression was used to evaluate the association between variables of interest and the primary outcome, defined as 90-day mRS 0-3. The final model performance was measured by area under the receiver operating characteristic curve (AUROC). Secondarily, we evaluated predictors of symptomatic intracranial hemorrhage (sICH) by ECASS-II definition.

Results Among 114 patients with LIC, median age was 65, 50% were female, median NIHSS was 19 [IQR 16-22], 35.1% received IV thrombolysis, and 8.8% experienced sICH. In univariable analysis, 3 or more EVT passes was associated with poor 90-day outcome (OR 2.80, p = 0.041); however, this association became nonsignificant after adjusting for covariables including age, NIHSS, and TICI score. In multivariable analysis, only age and NIHSS remained significantly associated with poor 90-day mRS. Age ≥75 led to about 5 times greater likelihood of poor outcome, and each 5-point increase of NIHSS increased the likelihood by approximately 10%. No significant variables predicting sICH were identified. Final model performance was reasonable (AUROC 0.771) for predicting 90-day mRS.

Conclusions

In this real-world cohort of patients with LIC undergoing EVT, ASPECTS and number of EVT passes were not associated, whereas age and NIHSS were the only significant predictors of poor 90-day outcome. More nuanced tools will be necessary to triage patients with LIC.

Authors/Disclosures
Harshita Cherukuri PRESENTER	Mr. Cherukuri has nothing to disclose.
Demi K. Waworuntu	Ms. Waworuntu has nothing to disclose.
Sergio A. Marioni	No disclosure on file
Monica Mallavarapu	Ms. Mallavarapu has nothing to disclose.
Ananya Iyyangar (UT Health Houston)	Ananya Iyyangar has nothing to disclose.
Sunil Sheth, MD (University of Texas At Houston)	Dr. Sheth has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Penumbra. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerenovus. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Imperative Care.
Jerome Jeevarajan	Mr. Jeevarajan has nothing to disclose.

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