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Safety and outcomes of endovascular treatment in patients with very severe acute ischemic stroke

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Abstract

Background

Patients with anterior circulation ischemic strokes due to large vessel occlusion (AIS-LVO) and very severe neurological deficits (National Institutes of Health Stroke Scale (NIHSS) score > 25) were under-represented in clinical trials on endovascular treatment (EVT). We aimed to evaluate safety and outcomes of EVT in patients with very severe vs. severe (NIHSS score 15–25) neurological deficits.

Methods

We included consecutive patients undergoing EVT for AIS-LVO between January 2015 and December 2019 at Lille University Hospital. We compared rates of parenchymal hemorrhage (PH), symptomatic intracranial hemorrhage (SICH), procedural complications, and 90-day mortality between patients with very severe vs. severe neurological deficit using univariable and multivariable logistic regression analyses. Functional outcome (90-days modified Rankin Scale) was compared between groups using ordinal logistic regression analysis.

Results

Among 1484 patients treated with EVT, 108 (7%) had pre-treatment NIHSS scores > 25, 873 (59%) with NIHSS scores 15–25 and 503 (34%) with NIHSS scores < 15. Rates of PH, SICH, successful recanalization, and procedural complications were similar in patients with NIHSS scores > 25 and NIHSS 15–25. Patients with NIHSS > 25 had a lower likelihood of improved functional outcome (adjcommon OR 0.31[95% CI 0.21–0.47]) and higher odds of mortality at 90 days (adjOR 2.3 [95% CI 1.5–3.7]) compared to patients with NIHSS 15–25. Successful recanalization was associated with better functional outcome (adjcommon OR 3.8 [95% CI 1.4–10.4]), and lower odds of mortality (adjOR 0.3 [95% CI 0.1–0.9]) in patients with very severe stroke. The therapeutic effect of recanalization on functional outcome and mortality was similar in both groups.

Conclusions

In patients with very severe neurological deficit, EVT was safe and successful recanalization was strongly associated with better functional outcome at 90 days.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Funding

The authors received no financial support for the research, authorship, and publication of this article.

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Authors and Affiliations

  1. Department of Interventional Neuroradiology, CHU Lille, 59000, Lille, France

    Fouzi Bala, Nicolas Bricout & Nasreddine Nouri

  2. Univ. Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience and Cognition, F-59000, Lille, France

    Charlotte Cordonnier, Hilde Henon & Barbara Casolla

  3. Department of Neurology, Stroke Unit, Univ. Côte d’Azur (UCA), CHU Nice, URRIS, Unité de Recherche Clinique Cote d’Azur-UR2CA, Nice, France

    Barbara Casolla

Authors
  1. Fouzi Bala
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  2. Nicolas Bricout
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Correspondence to Hilde Henon.

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The authors report no competing interest concerning this manuscript.

Ethical approval

The registry was approved by the relevant ethical committee (Comité de Protection des Personnes Nord Ouest IV Lille, France, March 9th, 2010, registration number 10.677). Patients were managed according to local rules without any investigation or treatment specifically performed for the purpose of this study. Patients gave consent themselves or via a close relative for the follow-up.

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Bala, F., Bricout, N., Nouri, N. et al. Safety and outcomes of endovascular treatment in patients with very severe acute ischemic stroke. J Neurol 269, 2493–2502 (2022). https://doi.org/10.1007/s00415-021-10807-z

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  • DOI: https://doi.org/10.1007/s00415-021-10807-z

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