E-045 Prognostic factors for acute ischemic stroke patients with and without neuroendovascular intervention
Authors: Zussman B , Olszewski A , Sell N , Galvao J , Colacino E , Maltenfort M , Tjoumakaris S , Dumont A , Rosenwasser R , Jabbour P , Gonzalez L 
Published: July 2012

Introduction

Baseline NIHSS score and time window (duration since ictus) are meaningful prognostic factors for acute ischemic stroke (AIS) patients treated with IV-tPA, but their value for patients treated with neuroendovascular interventions is less well defined.

Methods

IRB-approved retrospective review of prospectively-collected data for all patients that presented to a single comprehensive Stroke Center (SC) from January 1 to December 31, 2011, with AIS. Intervention was defined as successful/attempted endovascular neuro-thrombolysis/thrombectomy with intraarterial pharmacological and/or mechanical agents performed at SC. Patient parameters included NIHSS at presentation to SC (PreNIHSS), and duration from symptom onset until CT/CTA/CTP scanning (TimetoCT) and intervention (TimetoTX). Clinical outcome parameters included NIHSS at hospital discharge (DcNIHSS), duration of in-hospital stay from presentation to SC until discharge (LOS), modified Rankin Scale score at ≥90 days (mRS), and PreNIHSS minus DcNIHSS (DeltaNIHSS). We used multivariate regression and Spearman's correlation to analyze factors affecting clinical outcome, and recursive partitioning to identify an algorithm predictive of large DeltaNIHSS for patients with intervention.

Results

There were 344 patients with AIS and 64 (19%) had intervention. PreNIHSS was associated with clinical outcome for patients with and without intervention (Abstract E-045 table 1, Abstract E-045 Figure 1A). Time to CT was not associated with clinical outcome for patients with and without intervention (Abstract E-045 table 1), and Time to TX was not associated with clinical outcome for patients with intervention (Abstract E-045 table 2). For patients that had intervention, PreNIHSS > 12.5 and Time to CT <4.5 h or between 5.5 and 7.5 h predicted approximately 10 point DeltaNIHSS (Abstract E-045 Figure 1B). Recursive partitioning-predicted DeltaNIHSS correlated with actual DeltaNIHSS (Spearman's ρ=0.62, p<0.001).

Abstract E-045 Table 1

Prognostic association with clinical outcome

p ValueDC-NIHSSLOS90-day mRSDeltaNIHSSPre-NIHSS0.0000045 (SS)0.037 (SS)0.00012 (SS)0.075Time-to-CT0.70.640.420.7

Multivariate regression analysis. Statistical significance achieved at p=0.05.

SS, Statistical Significance.

Abstract E-045 Figure 1Abstract E-045 Table 2

Time-to-TX association with clinical outcome

Spearman's ρ (p Values)DC-NIHSSLOS90-day mRSDeltaNIHSSTime-to-TX0.16 (0.36)0.09 (0.58)0.04 (0.83)−0.12 (0.5)

Spearman's correlation analysis. Statistical significance achieved at p=0.05.

Conclusions

Lower baseline NIHSS scores predict better clinical outcomes in AIS patients with and without neuroendovascular intervention. Temporal window is not an independent predictor of clinical outcome. In patients with high baseline NIHSS scores, the therapeutic time window for neuroendovascular intervention may be quite broad.

Competing interests

B Zussman: None. A Olszewski: None. N Sell: None. J Galvao: None. E Colacino: None. M Maltenfort: None. S Tjoumakaris: Stryker Neurovascular. A Dumont: Stryker Neurovascular, ev3, MIcrovention. R Rosenwasser: Boston Scientific. P Jabbour: Codman Neurovascular, ev3. L. Gnzalez: ev3.