Predictors of good clinical outcomes, mortality, and successful revascularization in patients with acute ischemic stroke undergoing thrombectomy: pooled analysis of the Mechanical Embolus Removal in Cerebral Ischemia (MERCI) and Multi MERCI Trials.

Abstract:

BACKGROUND AND PURPOSE:The Mechanical Embolus Removal in Cerebral Ischemia (MERCI) and Multi MERCI trials evaluated the safety and efficacy of thrombectomy in the treatment of intracranial arterial occlusions within 8 hours of symptom onset. We sought to determine the predictors of clinical and angiographic outcomes in these patients. METHODS:The trial cohorts were combined in a data set of 305 patients. Twenty-eight baseline variables were included in univariate and multivariate analyses to define the independent predictors of good outcomes (modified Rankin Scale score or=150 mm Hg; OR, 0.42; 95% CI, 0.26 to 0.70; P=0.0007) and M2 occlusion (OR, 3.86; 95% CI, 1.28 to 11.67; P=0.0168) were independent predictors of revascularization. CONCLUSIONS:Final recanalization status represents the strongest predictor of clinical outcomes in patients undergoing thrombectomy. The ability to remove the clot is negatively influenced by systolic blood pressure on presentation perhaps because of the hydraulic forces imposed by higher blood pressures. Although internal carotid artery occlusions are associated with increased mortality, they do not appear to influence the chances of good outcomes. This finding supports the inclusion of internal carotid artery occlusions in future efficacy trials.

journal_name

Stroke

journal_title

Stroke

authors

Nogueira RG,Liebeskind DS,Sung G,Duckwiler G,Smith WS,MERCI.,Multi MERCI Writing Committee.

doi

10.1161/STROKEAHA.109.561431

subject

Has Abstract

pub_date

2009-12-01 00:00:00

pages

3777-83

issue

12

eissn

0039-2499

issn

1524-4628

pii

STROKEAHA.109.561431

journal_volume

40

pub_type

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