Clinical Outcome after Thrombectomy in Patients with Stroke with Premorbid Modified Rankin Scale Scores of 3 and 4: A Cohort Study with 136 Patients

We aimed to analyze the clinical outcome after mechanical thrombectomy in patients with premorbid mRS 3 and 4 because there are currently no data on this patient group. Between January 2009 and November 2017, all patients with premorbid mRS 3 or 4 undergoing mechanical thrombectomy due to anterior c...

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Published in:American journal of neuroradiology : AJNR 2019-02, Vol.40 (2), p.283-286
Main Authors: Seker, F, Pfaff, J, Schönenberger, S, Herweh, C, Nagel, S, Ringleb, P A, Bendszus, M, Möhlenbruch, M A
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Cohort Studies
Comorbidity
Female
Humans
Interventional
Male
Middle Aged
Retrospective Studies
Stroke - etiology
Stroke - surgery
Thrombectomy - adverse effects
Treatment Outcome
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Summary:We aimed to analyze the clinical outcome after mechanical thrombectomy in patients with premorbid mRS 3 and 4 because there are currently no data on this patient group. Between January 2009 and November 2017, all patients with premorbid mRS 3 or 4 undergoing mechanical thrombectomy due to anterior circulation stroke were selected. Good outcome was defined as a clinical recovery to the status before stroke onset (ie, equal premorbid mRS and mRS at 90 days). In addition, mortality at discharge and at 90 days was analyzed. One hundred thirty-six patients were included, of whom 81.6% presented with premorbid mRS 3; and 18.4%, with premorbid mRS 4; 24.0% of patients with premorbid mRS 4 achieved clinical recovery compared with 20.7% of patients with premorbid mRS 3 ( = .788). However, the proportion of hospital mortality and mortality at 90 days was nonsignificant, but markedly higher in patients with premorbid mRS 4. Multivariate analysis identified low NIHSS scores (OR, 0.92; 95% CI, 0.85-0.99; = .040), high ASPECTS (OR, 1.45; 95% CI, 1.02-2.16; = .049), and TICI 2b-3 (OR, 7.11; 95% CI, 1.73-49.90; = .017) as independent predictors of good outcome. Good outcome in patients with premorbid mRS 3 and 4 is less frequent compared with premorbid mRS 0-2. Nevertheless, about 20% of the patients return to their premorbid mRS, which may justify endovascular treatment. The most important predictor of good outcome is successful recanalization.
ISSN:0195-6108
1936-959X
DOI:10.3174/ajnr.A5920