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  • Predictors of Miraculous Recovery at 90 Days after Mechanical Thrombectomy for Large Vessel Occlusions

    Final Number:
    1122

    Authors:
    Anna Lynn; Fouad Chouairi; Michael Mercier; Samuel Aramis Cornelio Sommaruga MD; Stacy Chu; Andrew Koo; Branden John Cord MD, MS, PhD, BA; Ryan Matthew Hebert MD; Michele Johnson; Ajayy Malhotra; Caitlin Loomis; Hardik Amin; Jennifer Dearborn; David Y. Hwang MD; Nils Petersen; Dalton Neu; Karin Nystrom; Guido Falcone MD, ScD, MPH; Kevin Sheth; Lauren Sansing; Joseph Schindler; Charles Christian Matouk BSc MD

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Very good outcomes which can be considered “miraculous recoveries” have been observed in patients presenting with large stroke syndromes who undergo mechanical thrombectomy (MT). In a large sample of stroke patients treated at our stroke center, we aimed to identify patient-level factors that may predict miraculous recovery after MT.

    Methods: Consecutive acute ischemic stroke (AIS) patients who underwent MT for large vessel occlusions at a single center between January 2015 and November 2017 were retrospectively identified. The primary outcome measure was modified Rankin Score (mRS) at 90 days after MT, with a “miraculous recovery” defined as a 90 day mRS of 0-2. A multivariate regression model was built to assess factors that predicted miraculous recovery.

    Results: A total of 219 patients were included who had an AIS and underwent MT (mean age 71 [SD 15], female 129 [59%]). Of these patients, 72 (33%) showed miraculous recovery and 146 (67%) did not. Indicators that miraculous recovery would not be achieved included older age (odds ratio 0.922; 95% confidence interval [CI] 0.889-0.958; P<0.0001), high initial NIHSS (odds ratio 0.917; 95% CI 0.854-0.984; P=0.016), and high post-procedural NIHSS (odds ratio 0.803; 95% CI 0.740-0.871; P<0.0001). Miraculous recovery was associated with status as a current or former smoker (odds ratio 2.643; 95% CI 1.034-6.759; P=0.042).

    Conclusions: In a large population of patients who underwent MT for AIS, factors that were found to be independently associated with an increased probability of miraculous recovery (90 day post-procedure mRS 0-2) were younger age, smoking, low initial NIHSS, and low post-procedural NIHSS. These data may help inform discussions with patients and their surrogate decision-makers regarding expectations after mechanical thrombectomy for large vessel occlusions.

    Patient Care: These data may help inform discussions with patients and their surrogate decision-makers regarding expectations after mechanical thrombectomy for large vessel occlusions.

    Learning Objectives: 1. Identify predictive factors associated with miraculous recovery, defined as modified Rankin Score of 0-2 at 90 days, for patients who underwent mechanical thrombectomy following large vessel occlusion in acute ischemic stroke.

    References:

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