title: Predictors of poor outcome despite recanalization: a multiple regression analysis of the NASA registry.
abstract: BACKGROUND
  Mechanical thrombectomy with stent-retrievers results in higher recanalization rates compared with previous devices. Despite successful recanalization rates (Thrombolysis in Cerebral Infarction (TICI) score ≥2b) of 70-83%, good outcomes by 90-day modified Rankin Scale (mRS) score ≤2 are achieved in only 40-55% of patients. We evaluated predictors of poor outcomes (mRS >2) despite successful recanalization (TICI ≥2b) in the North American Solitaire Stent Retriever Acute Stroke (NASA) registry.
  
  
  METHODS
  Logistic regression was used to evaluate baseline characteristics and recanalization outcomes for association with 90-day mRS score of 0-2 (good outcome) vs 3-6 (poor outcome). Univariate tests were carried out for all factors. A multivariable model was developed based on backwards selection from the factors with at least marginal significance (p≤0.10) on univariate analysis with the retention criterion set at p≤0.05. The model was refit to minimize the number of cases excluded because of missing covariate values; the c-statistic was a measure of predictive power.
  
  
  RESULTS
  Of 354 patients, 256 (72.3%) were recanalized successfully. Based on 234 recanalized patients evaluated for 90-day mRS score, 116 (49.6%) had poor outcomes. Univariate analysis identified an increased risk of poor outcome for age ≥80 years, occlusion site of internal carotid artery (ICA)/basilar artery, National Institute of Health Stroke Scale (NIHSS) score ≥18, history of diabetes mellitus, TICI 2b, use of rescue therapy, not using a balloon-guided catheter or intravenous tissue plasminogen activator (IV t-PA), and >30 min to recanalization (p≤0.05). In multivariable analysis, age ≥80 years, occlusion site ICA/basilar, initial NIHSS score ≥18, diabetes, absence of IV t-PA, ≥3 passes, and use of rescue therapy were significant independent predictors of poor 90-day outcome in a model with good predictive power (c-index=0.80).
  
  
  CONCLUSIONS
  Age, occlusion site, high NIHSS, diabetes, no IV t-PA, ≥3 passes, and use of rescue therapy are associated with poor 90-day outcome despite successful recanalization.
authors.affiliation: Miami Cardiac and Vascular Institute, Baptist Hospital, Miami, Florida, USA Neuroscience Center, Baptist Hospital, Miami, Florida, USA.
authors.forename: Italo
authors.initials: I
authors.lastname: Linfante
authors.affiliation: Neuroscience Center, Baptist Hospital, Miami, Florida, USA Center for Research and Grants, Baptist Health South Florida, Coral Gables, Florida, USA.
authors.forename: Amy K
authors.initials: AK
authors.lastname: Starosciak
authors.affiliation: Center for Research and Grants, Baptist Health South Florida, Coral Gables, Florida, USA.
authors.forename: Gail R
authors.initials: GR
authors.lastname: Walker
authors.affiliation: Miami Cardiac and Vascular Institute, Baptist Hospital, Miami, Florida, USA Neuroscience Center, Baptist Hospital, Miami, Florida, USA.
authors.forename: Guilherme
authors.initials: G
authors.lastname: Dabus
authors.affiliation: Medical College of Wisconsin/Froedtert Hospital, Milwaukee, Wisconsin, USA.
authors.forename: Alicia C
authors.initials: AC
authors.lastname: Castonguay
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Rishi
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Chung-Huan J
authors.initials: CH
authors.lastname: Sun
authors.affiliation: St. Luke's Kansas City, Kansas City, Missouri, USA.
authors.forename: Coleman
authors.initials: C
authors.lastname: Martin
authors.affiliation: St. Luke's Kansas City, Kansas City, Missouri, USA.
authors.forename: William E
authors.initials: WE
authors.lastname: Holloway
authors.affiliation: Delray Medical Center, Delray Beach, Florida, USA.
authors.forename: Nils
authors.initials: N
authors.lastname: Mueller-Kronast
authors.affiliation: California Pacific Medical Center, San Francisco, California, USA.
authors.forename: Joey D
authors.initials: JD
authors.lastname: English
authors.affiliation: Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA.
authors.forename: Tim W
authors.initials: TW
authors.lastname: Malisch
authors.affiliation: Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA.
authors.forename: Franklin A
authors.initials: FA
authors.lastname: Marden
authors.affiliation: Oregon Health and Sciences, Portland, Oregon, USA.
authors.forename: Hormozd
authors.initials: H
authors.lastname: Bozorgchami
authors.affiliation: Wayne State University School of Medicine, Detroit, Michigan, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Xavier
authors.affiliation: West Virginia University Hospital, Morgantown, West Virginia, USA.
authors.forename: Ansaar T
authors.initials: AT
authors.lastname: Rai
authors.affiliation: Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Froehler
authors.affiliation: Provena St. Joseph Medical Center, Joliet, Illinois, USA.
authors.forename: Aamir
authors.initials: A
authors.lastname: Badruddin
authors.affiliation: Boston Medical Center, Boston, Massachusetts, USA.
authors.forename: Thanh N
authors.initials: TN
authors.lastname: Nguyen
authors.affiliation: St. Luke's Kansas City, Kansas City, Missouri, USA.
authors.forename: M Asif
authors.initials: MA
authors.lastname: Taqi
authors.affiliation: University of Kansas Medical Center, Kansas City, Kansas, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Abraham
authors.affiliation: Texas Stroke Institute, Plano, Texas, USA.
authors.forename: Vallabh
authors.initials: V
authors.lastname: Janardhan
authors.affiliation: Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Hashem
authors.initials: H
authors.lastname: Shaltoni
authors.affiliation: UT Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Roberta
authors.initials: R
authors.lastname: Novakovic
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Albert J
authors.initials: AJ
authors.lastname: Yoo
authors.affiliation: Baptist Health Louisville, Louisville, Kentucky, USA.
authors.forename: Alex
authors.initials: A
authors.lastname: Abou-Chebl
authors.affiliation: The University of Texas Medical School at Houston, Houston, Texas, USA.
authors.forename: Peng R
authors.initials: PR
authors.lastname: Chen
authors.affiliation: Methodist Neurological Institute, Houston, Texas, USA.
authors.forename: Gavin W
authors.initials: GW
authors.lastname: Britz
authors.affiliation: St Louis University, St Louis, Missouri, USA.
authors.forename: Ritesh
authors.initials: R
authors.lastname: Kaushal
authors.affiliation: University of Missouri, Columbia, Missouri, USA.
authors.forename: Ashish
authors.initials: A
authors.lastname: Nanda
authors.affiliation: Medical College of Wisconsin/Froedtert Hospital, Milwaukee, Wisconsin, USA.
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: Issa
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Raul G
authors.initials: RG
authors.lastname: Nogueira
authors.affiliation: Medical College of Wisconsin/Froedtert Hospital, Milwaukee, Wisconsin, USA.
authors.forename: Osama O
authors.initials: OO
authors.lastname: Zaidat
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009656:North America / Q000453:epidemiology; D011237:Predictive Value of Tests; D012042:Registries; D012044:Regression Analysis; D015424:Reperfusion / Q000295:instrumentation / Q000379:methods*; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D016896:Treatment Outcome
keywords: Angiography; Intervention; Stroke; Thrombectomy