Predictors of Outcomes Following Catheter-Based Therapy for Acute Stroke Article
Full Text via DOI: 10.1002/ccd.25755 PMID: 25413726 Web of Science: 000353360800022
- Htyte, Nay; Parto, Parham; Ragbir, Shawn; Jaffe, Leeor; White, Christopher J.
- BackgroundTimely reperfusion directly impacts favorable neurologic outcomes in acute ischemic stroke (AIS) patients. Most strokes present outside the 3-4.5 h window for intravenous thrombolysis (IV-tPA). Catheter-based therapy (CBT) is commonly used in patients not eligible for timely IV-tPa, but variables that predict good neurologic outcomes are poorly understood.; Methods Results of 124 consecutive AIS patients who received CBT at Ochsner Medical Center from 2006 and 2012 are reported. A modified Rankin score (mRs) of2 at 90 day post-CBT was used as the primary measurement of a good neurologic outcome. All-cause mortality during the index hospitalization, 30 days from treatment, and at 1 year were reported. Results are reported as those treated by Interventional Cardiologists (IC) or by Neurointerventionalists (NI).; ResultsThe mean age was 6516 years of which 48% (n=52) were male. The mean NIHSS was 15.0 +/- 7.5. Thrombolysis in cerebral infarction (TICI) 2 flow was achieved in 80% (n=100). Good neurologic outcome was observed in 64% (n=37 of 58) of patients 65 years or younger while in those older than 65, only 36% (n=24 of 66) had the same outcome (P=0.002). Mortality at 30 days for the two age groups were 21% (n=12) vs. 50% (n=33) (P=<0.001) respectively. A good neurologic outcome at 90 days was seen in 57% of patients with restoration of TICI2 flow compared to 17% with TICI<2 flow (P=<0.001). Those with failed reperfusion (TICI<2 flow) had 30-day mortality rate of 54% (13 of 24) vs. 20% (19 of 97) in those with TICI2 flow (P=<0.001). At 90 days, there was no significant differences in patient outcomes between IC (n=58) and NI (n=66) treated patients.; ConclusionSuccessful revascularization with CBT leads to a good neurologic outcome in selected stroke patients. Medical co-morbidities and increased age>65 years contributed to poor outcomes. To support broadening the number of physicians qualified to perform catheter-based stroke interventions, this study demonstrates that IC participating on a stroke team achieve comparable outcomes to NI. (c) 2014 Wiley Periodicals, Inc.
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