title: Recanalisation success is associated with good clinical outcome despite advanced age and stroke severity in patients treated with the Solitaire stentriever.
abstract: Intravenous recombinant tissue plasminogen activator is associated with significant recanalisation failure in the setting of large artery occlusion. Endovascular treatment by stentriever achieves improved rates of recanalisation but its impact on clinical outcomes remains unclear. We hypothesise that successful recanalisation, unattentuated by age and stroke severity, is associated with improved clinical outcomes in patients treated with the Solitaire stentriever (ev3 Endovascular, Plymouth, MN, USA). We conducted a retrospective study of 60 consecutive acute ischaemic stroke patients treated with the Solitaire stentriever. The data included demographics, vascular risk factors, ictal onset time, National Institutes of Health Stroke Scale (NIHSS) score at presentation, angiographic findings, post-procedure imaging, and clinical follow-up. Recanalisation success was defined as a thrombolysis in cerebral infarction score (TICI) ≥ 2b. Good clinical outcome was defined as a modified Rankin Scale score (mRS) ≤ 2 at 3 months. Of the 60 patients, the mean age was 64.1 (standard deviation 13.4) years and 68.3% were men. Median NIHSS score at presentation was 18 (interquartile range 14-22). Successful recanalisation (TICI ≥ 2b) was achieved in 44 patients (73.3%). Of these 44 patients, 25 patients (56.8%) achieved mRS ≤ 2 at 3months. Multiple logistic regression showed significant association between recanalisation success and improved clinical outcome (p=0.019). Of all patients, four (6.7%) developed symptomatic intracranial haemorrhage. Overall mortality was 28.3%. In conclusion, the Solitaire stentriever was associated with improved recanalisation rates. We showed that successful recanalisation is associated with good clinical outcomes after adjustments for age, sex and stroke severity.
authors.affiliation: Melbourne Brain Centre, The University of Melbourne, The Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3050, Australia.
authors.forename: Mun Yoong
authors.initials: MY
authors.lastname: Cheang
authors.affiliation: The University of Melbourne, Department of Radiology, The Royal Melbourne Hospital, Melbourne, VIC, Australia.
authors.forename: Nathan
authors.initials: N
authors.lastname: Manning
authors.affiliation: National Stroke Research Unit, Florey Neuroscience Institute, Melbourne, VIC, Australia.
authors.forename: Leonid
authors.initials: L
authors.lastname: Churilov
authors.affiliation: NeuroIntervention Service, The Royal Melbourne Hospital, Melbourne, VIC, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Mitchell
authors.affiliation: The University of Melbourne, Department of Radiology, The Royal Melbourne Hospital, Melbourne, VIC, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Dowling
authors.affiliation: Melbourne Brain Centre, The University of Melbourne, The Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3050, Australia. Electronic address: bernard.yan@mh.org.au.
authors.forename: Bernard
authors.initials: B
authors.lastname: Yan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000401:mortality / Q000601:surgery; D057510:Endovascular Procedures / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D061185:Mechanical Thrombolysis / Q000379:methods* / Q000401:mortality; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome
keywords: Acute ischaemic stroke; NIHSS; Solitaire stentriever; TICI; mRS