Predictors of Mortality in Acute Ischemic Stroke Intervention: Analysis of the North American Solitaire Acute Stroke Registry

Italo Linfante, Gail R. Walker, Alicia C. Castonguay, Guilherme Dabus, Amy K. Starosciak, Albert J. Yoo, Alex Abou-Chebl, Gavin W. Britz, Franklin A. Marden, Alexandria Alvarez, Rishi Gupta, Chun Huan J. Sun, Coleman Martin, William E. Holloway, Nils Mueller-Kronast, Joey D. English, Tim W. Malisch, Hormozd Bozorgchami, Andrew Xavier, Ansaar T. RaiMichael T. Froehler, Aamir Badruddin, Thanh N. Nguyen, M. Asif Taqi, Michael G. Abraham, Vallabh Janardhan, Hashem Shaltoni, Roberta Novakovic, Peng R. Chen, Ritesh Kaushal, Ashish Nanda, Mohammad A. Issa, Raul G. Nogueira, Osama O. Zaidat

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE: Failure to recanalize predicts mortality in acute ischemic stroke. In the North American Solitaire Acute Stroke registry, we investigated parameters associated with mortality in successfully recanalized patients.

METHODS: Logistic regression was used to evaluate baseline characteristics and recanalization parameters for association with 90-day mortality. A multivariable model was developed based on backward selection with retention criteria of P<0.05 from factors with at least marginal significance (P≤0.10), then refit to minimize the number of excluded cases (missing data).

RESULTS: Successfully recanalized patients had lower mortality (25.2% [59/234] versus 46.9% [38/81] P<0.001). There was no difference in symptomatic intracranial hemorrhage between patients with successful versus failed recanalization (9% [21/234] versus 14% [11/79]; P=0.205). However, mortality was significantly higher in patients with symptomatic intracranial hemorrhage (72% [23/32] versus 26% [73/281]; P<0.001). Proximal occlusion (internal carotid artery or vertebrobasilar), initial National Institutes of Health Stroke Scale≥18, use of rescue therapy (P<0.05), and 3+ passes (P<0.10) were associated with mortality in recanalized patients. In the multivariate model with good predictive power (c index=0.72), proximal occlusion, initial National Institutes of Health Stroke Scale≥18, and use of rescue therapy remained significant independent predictors of 90-day mortality.

CONCLUSIONS: Failure to recanalize and presence of symptomatic intracranial hemorrhage resulted in increased mortality. Despite successful recanalization, proximal occlusion, high National Institutes of Health Stroke Scale, and need for rescue therapy were predictors of mortality.

Original languageEnglish (US)
Pages (from-to)2305-2308
Number of pages4
JournalStroke; a journal of cerebral circulation
Volume46
Issue number8
DOIs
StatePublished - Aug 1 2015
Externally publishedYes

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Registries
Stroke
Mortality
Intracranial Hemorrhages
National Institutes of Health (U.S.)
Internal Carotid Artery
Therapeutics
Logistic Models

Keywords

  • carotid artery, internal
  • intracra
  • mortality
  • nial hemorrhages
  • stroke
  • thrombectomy

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Predictors of Mortality in Acute Ischemic Stroke Intervention : Analysis of the North American Solitaire Acute Stroke Registry. / Linfante, Italo; Walker, Gail R.; Castonguay, Alicia C.; Dabus, Guilherme; Starosciak, Amy K.; Yoo, Albert J.; Abou-Chebl, Alex; Britz, Gavin W.; Marden, Franklin A.; Alvarez, Alexandria; Gupta, Rishi; Sun, Chun Huan J.; Martin, Coleman; Holloway, William E.; Mueller-Kronast, Nils; English, Joey D.; Malisch, Tim W.; Bozorgchami, Hormozd; Xavier, Andrew; Rai, Ansaar T.; Froehler, Michael T.; Badruddin, Aamir; Nguyen, Thanh N.; Taqi, M. Asif; Abraham, Michael G.; Janardhan, Vallabh; Shaltoni, Hashem; Novakovic, Roberta; Chen, Peng R.; Kaushal, Ritesh; Nanda, Ashish; Issa, Mohammad A.; Nogueira, Raul G.; Zaidat, Osama O.

In: Stroke; a journal of cerebral circulation, Vol. 46, No. 8, 01.08.2015, p. 2305-2308.

Research output: Contribution to journalArticle

Linfante, I, Walker, GR, Castonguay, AC, Dabus, G, Starosciak, AK, Yoo, AJ, Abou-Chebl, A, Britz, GW, Marden, FA, Alvarez, A, Gupta, R, Sun, CHJ, Martin, C, Holloway, WE, Mueller-Kronast, N, English, JD, Malisch, TW, Bozorgchami, H, Xavier, A, Rai, AT, Froehler, MT, Badruddin, A, Nguyen, TN, Taqi, MA, Abraham, MG, Janardhan, V, Shaltoni, H, Novakovic, R, Chen, PR, Kaushal, R, Nanda, A, Issa, MA, Nogueira, RG & Zaidat, OO 2015, 'Predictors of Mortality in Acute Ischemic Stroke Intervention: Analysis of the North American Solitaire Acute Stroke Registry', Stroke; a journal of cerebral circulation, vol. 46, no. 8, pp. 2305-2308. https://doi.org/10.1161/STROKEAHA.115.009530
Linfante, Italo ; Walker, Gail R. ; Castonguay, Alicia C. ; Dabus, Guilherme ; Starosciak, Amy K. ; Yoo, Albert J. ; Abou-Chebl, Alex ; Britz, Gavin W. ; Marden, Franklin A. ; Alvarez, Alexandria ; Gupta, Rishi ; Sun, Chun Huan J. ; Martin, Coleman ; Holloway, William E. ; Mueller-Kronast, Nils ; English, Joey D. ; Malisch, Tim W. ; Bozorgchami, Hormozd ; Xavier, Andrew ; Rai, Ansaar T. ; Froehler, Michael T. ; Badruddin, Aamir ; Nguyen, Thanh N. ; Taqi, M. Asif ; Abraham, Michael G. ; Janardhan, Vallabh ; Shaltoni, Hashem ; Novakovic, Roberta ; Chen, Peng R. ; Kaushal, Ritesh ; Nanda, Ashish ; Issa, Mohammad A. ; Nogueira, Raul G. ; Zaidat, Osama O. / Predictors of Mortality in Acute Ischemic Stroke Intervention : Analysis of the North American Solitaire Acute Stroke Registry. In: Stroke; a journal of cerebral circulation. 2015 ; Vol. 46, No. 8. pp. 2305-2308.
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abstract = "BACKGROUND AND PURPOSE: Failure to recanalize predicts mortality in acute ischemic stroke. In the North American Solitaire Acute Stroke registry, we investigated parameters associated with mortality in successfully recanalized patients.METHODS: Logistic regression was used to evaluate baseline characteristics and recanalization parameters for association with 90-day mortality. A multivariable model was developed based on backward selection with retention criteria of P<0.05 from factors with at least marginal significance (P≤0.10), then refit to minimize the number of excluded cases (missing data).RESULTS: Successfully recanalized patients had lower mortality (25.2{\%} [59/234] versus 46.9{\%} [38/81] P<0.001). There was no difference in symptomatic intracranial hemorrhage between patients with successful versus failed recanalization (9{\%} [21/234] versus 14{\%} [11/79]; P=0.205). However, mortality was significantly higher in patients with symptomatic intracranial hemorrhage (72{\%} [23/32] versus 26{\%} [73/281]; P<0.001). Proximal occlusion (internal carotid artery or vertebrobasilar), initial National Institutes of Health Stroke Scale≥18, use of rescue therapy (P<0.05), and 3+ passes (P<0.10) were associated with mortality in recanalized patients. In the multivariate model with good predictive power (c index=0.72), proximal occlusion, initial National Institutes of Health Stroke Scale≥18, and use of rescue therapy remained significant independent predictors of 90-day mortality.CONCLUSIONS: Failure to recanalize and presence of symptomatic intracranial hemorrhage resulted in increased mortality. Despite successful recanalization, proximal occlusion, high National Institutes of Health Stroke Scale, and need for rescue therapy were predictors of mortality.",
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TY - JOUR

T1 - Predictors of Mortality in Acute Ischemic Stroke Intervention

T2 - Analysis of the North American Solitaire Acute Stroke Registry

AU - Linfante, Italo

AU - Walker, Gail R.

AU - Castonguay, Alicia C.

AU - Dabus, Guilherme

AU - Starosciak, Amy K.

AU - Yoo, Albert J.

AU - Abou-Chebl, Alex

AU - Britz, Gavin W.

AU - Marden, Franklin A.

AU - Alvarez, Alexandria

AU - Gupta, Rishi

AU - Sun, Chun Huan J.

AU - Martin, Coleman

AU - Holloway, William E.

AU - Mueller-Kronast, Nils

AU - English, Joey D.

AU - Malisch, Tim W.

AU - Bozorgchami, Hormozd

AU - Xavier, Andrew

AU - Rai, Ansaar T.

AU - Froehler, Michael T.

AU - Badruddin, Aamir

AU - Nguyen, Thanh N.

AU - Taqi, M. Asif

AU - Abraham, Michael G.

AU - Janardhan, Vallabh

AU - Shaltoni, Hashem

AU - Novakovic, Roberta

AU - Chen, Peng R.

AU - Kaushal, Ritesh

AU - Nanda, Ashish

AU - Issa, Mohammad A.

AU - Nogueira, Raul G.

AU - Zaidat, Osama O.

PY - 2015/8/1

Y1 - 2015/8/1

N2 - BACKGROUND AND PURPOSE: Failure to recanalize predicts mortality in acute ischemic stroke. In the North American Solitaire Acute Stroke registry, we investigated parameters associated with mortality in successfully recanalized patients.METHODS: Logistic regression was used to evaluate baseline characteristics and recanalization parameters for association with 90-day mortality. A multivariable model was developed based on backward selection with retention criteria of P<0.05 from factors with at least marginal significance (P≤0.10), then refit to minimize the number of excluded cases (missing data).RESULTS: Successfully recanalized patients had lower mortality (25.2% [59/234] versus 46.9% [38/81] P<0.001). There was no difference in symptomatic intracranial hemorrhage between patients with successful versus failed recanalization (9% [21/234] versus 14% [11/79]; P=0.205). However, mortality was significantly higher in patients with symptomatic intracranial hemorrhage (72% [23/32] versus 26% [73/281]; P<0.001). Proximal occlusion (internal carotid artery or vertebrobasilar), initial National Institutes of Health Stroke Scale≥18, use of rescue therapy (P<0.05), and 3+ passes (P<0.10) were associated with mortality in recanalized patients. In the multivariate model with good predictive power (c index=0.72), proximal occlusion, initial National Institutes of Health Stroke Scale≥18, and use of rescue therapy remained significant independent predictors of 90-day mortality.CONCLUSIONS: Failure to recanalize and presence of symptomatic intracranial hemorrhage resulted in increased mortality. Despite successful recanalization, proximal occlusion, high National Institutes of Health Stroke Scale, and need for rescue therapy were predictors of mortality.

AB - BACKGROUND AND PURPOSE: Failure to recanalize predicts mortality in acute ischemic stroke. In the North American Solitaire Acute Stroke registry, we investigated parameters associated with mortality in successfully recanalized patients.METHODS: Logistic regression was used to evaluate baseline characteristics and recanalization parameters for association with 90-day mortality. A multivariable model was developed based on backward selection with retention criteria of P<0.05 from factors with at least marginal significance (P≤0.10), then refit to minimize the number of excluded cases (missing data).RESULTS: Successfully recanalized patients had lower mortality (25.2% [59/234] versus 46.9% [38/81] P<0.001). There was no difference in symptomatic intracranial hemorrhage between patients with successful versus failed recanalization (9% [21/234] versus 14% [11/79]; P=0.205). However, mortality was significantly higher in patients with symptomatic intracranial hemorrhage (72% [23/32] versus 26% [73/281]; P<0.001). Proximal occlusion (internal carotid artery or vertebrobasilar), initial National Institutes of Health Stroke Scale≥18, use of rescue therapy (P<0.05), and 3+ passes (P<0.10) were associated with mortality in recanalized patients. In the multivariate model with good predictive power (c index=0.72), proximal occlusion, initial National Institutes of Health Stroke Scale≥18, and use of rescue therapy remained significant independent predictors of 90-day mortality.CONCLUSIONS: Failure to recanalize and presence of symptomatic intracranial hemorrhage resulted in increased mortality. Despite successful recanalization, proximal occlusion, high National Institutes of Health Stroke Scale, and need for rescue therapy were predictors of mortality.

KW - carotid artery, internal

KW - intracra

KW - mortality

KW - nial hemorrhages

KW - stroke

KW - thrombectomy

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