Baseline predictors of poor clinical outcome despite recanalization of distal middle cerebral artery occlusions

ObjectiveMechanical thrombectomy (MT) is well-established for the treatment of acute ischemic stroke (AIS) from large vessel occlusion (LVO), with growing data supporting the expansion to distal and medium vessel occlusions (DMVO). Despite successful recanalization in DMVO, certain patients still experience poor long-term clinical outcomes, prompting our study to comprehensively explore pre-MT factors influencing outcome despite excellent recanalization (final modified Thrombolysis in Cerebral Infarction [mTICI] score ≥2c).MethodsWe retrospectively examined data from patients who consecutively underwent MT for a primary middle cerebral artery (MCA) DMVO across 37 centers in North America, Asia, and Europe. We identified baseline clinical and imaging factors associated with poor clinical outcome (defined as a modified Rankin Scale [mRS] score of 3-6) at 3 months, despite excellent recanalization using a multivariable model.ResultsBetween September 2017 and July 2021, 623 patients achieved mTICI > 2b and they were included in our study. Among them, 198 (32%) experienced a poor clinical outcome (mRS 3-6). Predictors of poor clinical outcome included higher age (OR 1.05 [1.03-1.07], <i>p</i> <i><</i> 0.001), higher NIHSS at admission (OR 1.12 [1.08-1.15], <i>p</i> <i><</i> 0.001), higher baseline mRS (OR 1.77 [0.96-3.26], <i>p</i> <i>=</i> 0.067), and diabetes (OR 1.59 [1.01-2.48], <i>p</i> <i>=</i> 0.044). Higher ASPECTS was associated with a decreased risk of poor clinical outcome (OR 0.82 [0.71-0.94], <i>p</i> <i>=</i> 0.006).ConclusionOlder age, diabetes, higher baseline mRS, and NIHSS were associated with poor clinical outcome in MCA DMVO despite excellent recanalization. Conversely, a higher ASPECTS decreased the probability of such an outcome.

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Journal
Interventional Neuroradiology
Published
2025-07-16
DOI
https://doi.org/10.1177/15910199251342841
Citations
2
Primary Topic
Acute Ischemic Stroke Management
Type
article
Field-Weighted Citation Impact
2.71
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article

Baseline predictors of poor clinical outcome despite recanalization of distal middle cerebral artery occlusions

Sunil A. Sheth, Jeremy Josef Heit, Mohammad Ali Aziz‐Sultan, Joshua D. Bernstock et al.
2 citations
Interventional Neuroradiology
Acute Ischemic Stroke Management
2.71
article

Baseline predictors of poor clinical outcome despite recanalization of distal middle cerebral artery occlusions

Sunil A. Sheth, Jeremy Josef Heit, Mohammad Ali Aziz‐Sultan, Joshua D. Bernstock, Tobias Djamsched Faizy, Ajit S Puri, Hamza A. Shaikh, Luca Scarcia, Constantin Hecker, Pablo Harker, Maud Wang, Alessandro Pedicelli, Benjamin Gory, Simona Nedelcu, Markus Alfred Möhlenbruch, Ricardo Varela, David S. Liebeskind, Aymeric Rouchaud, Hamza Adel Salim, Vincent Costalat, Benjamin Yong‐Qiang Tan, Nimer Adeeb, Julian Spears, David Altschul, Muhammed Amir Essibayi, Boris Lubicz, Nestor R. Gonzalez, Nicole M Cancelliere, Robert Fahed, Nils Henninger, Anna Luisa Kühn, Adam Andrew Dmytriw, Sherief Ghozy, Leonardo Renieri, Jane Khalife, Marco Colasurdo, Gaultier Marnat, Thanh N. Nguyen, Jens Fiehler, Robert William Regenhardt, Pascal M. Jabbour, Frédéric Clarençon, Thomas R. Marotta, João Pedro Filipe, Ashkan Mowla, Takahiro Ota, Andrea Maria Alexandre, Illario Tancredi, Vivek Srikar Yedavalli, Christian Paul Stracke, Răzvan Alexandru Radu, Vítor Mendes Pereira, Sri Hari Sundararajan, Adrien Guenego, Basel Musmar, Aman B. Patel, Christian Dyzmann, Amanda Baker, Erwah Kalsoum, Arundhati Biswas, Imene Chafai
article en
2 citations

Abstract

ObjectiveMechanical thrombectomy (MT) is well-established for the treatment of acute ischemic stroke (AIS) from large vessel occlusion (LVO), with growing data supporting the expansion to distal and medium vessel occlusions (DMVO). Despite successful recanalization in DMVO, certain patients still experience poor long-term clinical outcomes, prompting our study to comprehensively explore pre-MT factors influencing outcome despite excellent recanalization (final modified Thrombolysis in Cerebral Infarction [mTICI] score ≥2c).MethodsWe retrospectively examined data from patients who consecutively underwent MT for a primary middle cerebral artery (MCA) DMVO across 37 centers in North America, Asia, and Europe. We identified baseline clinical and imaging factors associated with poor clinical outcome (defined as a modified Rankin Scale [mRS] score of 3-6) at 3 months, despite excellent recanalization using a multivariable model.ResultsBetween September 2017 and July 2021, 623 patients achieved mTICI > 2b and they were included in our study. Among them, 198 (32%) experienced a poor clinical outcome (mRS 3-6). Predictors of poor clinical outcome included higher age (OR 1.05 [1.03-1.07], <i>p</i> <i><</i> 0.001), higher NIHSS at admission (OR 1.12 [1.08-1.15], <i>p</i> <i><</i> 0.001), higher baseline mRS (OR 1.77 [0.96-3.26], <i>p</i> <i>=</i> 0.067), and diabetes (OR 1.59 [1.01-2.48], <i>p</i> <i>=</i> 0.044). Higher ASPECTS was associated with a decreased risk of poor clinical outcome (OR 0.82 [0.71-0.94], <i>p</i> <i>=</i> 0.006).ConclusionOlder age, diabetes, higher baseline mRS, and NIHSS were associated with poor clinical outcome in MCA DMVO despite excellent recanalization. Conversely, a higher ASPECTS decreased the probability of such an outcome.

Interventional Neuroradiology
Rutgers, The State University of New Jersey (US), University of Southern California (US), Cedars-Sinai Medical Center (US), Brigham and Women's Hospital (US), Boston Medical Center (US), Centre National de la Recherche Scientifique (FR), St. Michael's Hospital (CA), Albert Einstein College of Medicine (US), Westchester Medical Center (US), Mayo Clinic (US), Montefiore Medical Center (US), Harvard University (US), Johns Hopkins University (US), Thomas Jefferson University (US), Inserm (FR), Universität Hamburg (DE), Oregon Health & Science University (US), National University of Singapore (SG), University of Massachusetts Chan Medical School (US), New York Medical College (US), Université Sorbonne Nouvelle (FR), Université de Montpellier (FR), Heidelberg University (DE), Louisiana State University in Shreveport (US), UCLA Health (US), Cooper University Hospital (US), Ottawa Hospital (CA), Erasmus Hospital (BE), University Hospital Heidelberg (DE), Agostino Gemelli University Polyclinic (IT), Johns Hopkins Bayview Medical Center (US), Sorbonne Université (FR), University of Chicago (US), Massachusetts General Hospital (US), Cooper Medical School of Rowan University (US), Centre Hospitalier Régional et Universitaire de Nancy (FR), Sana Kliniken AG (DE), University Hospital Münster (DE), Bordeaux Population Health (FR), Christian Doppler Klinik (AT), University Medical Center Hamburg-Eppendorf (DE), Hôpital Gui de Chauliac (FR), Imagerie Adaptative Diagnostique et Interventionnelle (FR), Pitié-Salpêtrière Hospital (FR), St Michael's Hospital (GB), Stanford Medicine (US), Hôpital Civil de Charleroi (BE), National University Hospital (SG), Tokyo Metropolitan Tama Medical Center (JP), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Centro Hospitalar do Porto (PT), Neurological Surgery (US), Hôpital Dupuytren (FR), University of Cincinnati (US), Université de Limoges (FR), The University of Texas Health Science Center at Houston (US), University of Cincinnati Medical Center (US)
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Acute Ischemic Stroke Management
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