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Long-term outcome changes after mechanical thrombectomy for anterior circulation acute ischemic stroke

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Abstract

Background and purpose

Mechanical thrombectomy (MT) improves early clinical outcome in patients with acute ischemic stroke but insights on determinants of long-term outcome after MT treatment are scarce.

Methods

Data from stroke patients with anterior circulation large vessel occlusion of a prospective MT registry (01/2014–06/2017) of a large comprehensive stroke center were analyzed regarding clinical outcome between short- (3 months) and long-term (12 months) assessment reflected by a change of modified Rankin scores (∆mRS). Secondary endpoints included favorable long-term outcome (mRS 0–2). Multi-variable regression analysis was performed to identify determinants of outcome changes and favorable outcome at long term.

Results

Of 264 patients included, 42.0% showed a favorable long-term outcome. Longitudinal analysis found that some individuals still improved, but no overall mRS difference between short and long-term follow-up was detected [∆mRS − 0.004 (95% CI − 0.020; 0.013); p = 0.672]. Right hemispheric stroke [∆mRS 0.286 (0.011; 0.561); p = 0.043] and high NIHSS at discharge [∆mRS, 0.039 (0.004; 0.074); p = 0.029] were associated with a longitudinal mRS decline. Favorable long-term outcome was associated with successful recanalization (p < 0.0001).

Conclusions

A significant number of patients with MT experience a favorable long-term outcome. Outcomes remained stable between short- and long-term follow-up, but some individuals may still show improvement beyond short-term rehabilitation. Right hemispheric stroke and clinical stroke severity at hospital discharge may be frail predictors for delayed decline of functional status, whereas successful recanalization remains a positive outcome predictor. Death rarely occurs beyond 3 months after MT treatment.

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Author notes

  1. Hannah Fuhrer, Lisa Forner, Wolf-Dirk Niesen and Stephan Meckel contributed equally to first/senior authorship.

Authors and Affiliations

  1. Department of Neurology, University Hospital Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany

    Hannah Fuhrer, Lena-Alexandra Beume, Juergen Bardutzky, Cornelius Weiller & Wolf-Dirk Niesen

  2. Department of Neuroradiology, Medical Center, University Hospital Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany

    Lisa Forner, Pascal Pruellage, Hannes Schacht, Karl Egger, Horst Urbach & Stephan Meckel

  3. Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Stefan-Meier-Straße 26, 79104, Freiburg, Germany

    Susanne Weber

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Corresponding author

Correspondence to Hannah Fuhrer.

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Conflicts of interest

Dr. Fuhrer has nothing to disclose. Dr. Forner has nothing to disclose. Mr. Pruellage has nothing to disclose. Dr. Schacht has nothing to disclose. Ms. Weber has nothing to disclose. Dr. Beume has nothing to disclose. Prof. Bardutzky reports speaking honoraria from Bayer Health Care, Boehringer Ingelheim, Daiichi Sankyo and Pfizerm, outside the submitted work. Prof. Weiller has nothing to disclose. Dr. Egger is shareholder of the VeoBrain GmbH and reports honoraria payments for specific speeches and seminar presentations from Stryker, outside the submitted work. Prof. Urbach is shareholder of the VeoBrain GmbH, outside the submitted work. Dr. Niesen has nothing to disclose. Prof. Meckel reports consultant fees for membership of the scientific advisory board of Acandis; speaker honorarium (modest), travel grant, video case support (non-financial) from Medtronic; travel grants from Microvention; Stryker; research grant (money paid to institution) from Bracco S.p.A; consultant fee from Novartis Pharma GmbH, all outside the submitted work.

Ethical standards

This study was carried out in accordance with the Declaration of Helsinki and the recommendations and approval of the protocol of the ethics committee, Germany (University of Freiburg, EK2/13, date of approval 05/28/2013).

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Informed patients’ consent was obtained

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Fuhrer, H., Forner, L., Pruellage, P. et al. Long-term outcome changes after mechanical thrombectomy for anterior circulation acute ischemic stroke. J Neurol 267, 1026–1034 (2020). https://doi.org/10.1007/s00415-019-09670-w

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  • DOI: https://doi.org/10.1007/s00415-019-09670-w

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