Abstract Body: Introduction:
Despite the efficacy and safety of endovascular treatment (EVT) demonstrated in many large-core randomized controlled trials, up to half of the patients experience very poor outcomes, suggesting a significant number of futile treatments. We aimed to identify predictors of very poor 30-day outcomes (mRS 5-6) after endovascular thrombectomy in patients with large infarct.
Methods:
We conducted a prospective, multicenter, observational study in Vietnam involving four comprehensive stroke centers, screening all consecutive patients who underwent EVT within 24 hours of symptom onset from August 2023 to August 2024. Large cores were defined by an Alberta Stroke Program Early CT Score (ASPECTS) of 3-5 on non-contrast CT or DWI-MRI and were assessed by two ASPECTS-certified stroke neurologists, with disagreements resolved by a senior reader. Risk factors were analyzed using multivariable logistic regression models. Prognosis was evaluated using the modified Rankin Scale (mRS), with very poor outcomes defined as a mRS score of 5-6 at 30-day follow-up. The study adheres to STROBE criteria and is registered as NCT06016348.
Results:
Of the 1,910 patients screened, a total of 361 (18.9%) were included, with a median age of 64.0 years (55.0-70.0) and a median ASPECTS of 4.0 (4.0-5.0). Of these, 145 patients (40.2%) had a mRS of 5-6 at 30-day follow-up. In multivariable analysis, pretreatment predictors included age (aOR 1.06, 95% CI: 1.04-1.08, p <0.0001), a history of atrial fibrillation (aOR 2.65, 95% CI: 1.31-5.47, p=0.007), higher baseline NIHSS (aOR 1.06, 95% CI: 1.01-1.11, p=0.02), anterior cerebral artery (ACA) lesion (aOR 2.72, 95% CI: 1.12-6.82, p=0.03), and higher glucose levels (mmol/dL) (aOR 1.03, 95% CI: 1.01-1.08, p=0.02) and lower ASPECTS (aOR 1.36, 95% CI: 1.008-1.85, p=0.04). The multivariable model demonstrated strong predictive accuracy, with an area under the receiver operating characteristic (ROC) curve of 0.789.
Conclusions:
This study demonstrates that advanced age, higher NIHSS scores, a history of atrial fibrillation, pre-operative glucose levels, ACA lesions, and lower ASPECTS are predictors of very poor outcomes in patients with large ischemic core thrombectomy, which may inform treatment decisions of EVT.