Predictors of poor outcome despite recanalization

A multiple regression analysis of the NASA registry

Italo Linfante, Amy K. Starosciak, Gail R. Walker, Guilherme Dabus, Alicia C. Castonguay, Rishi Gupta, Chung Huan J. Sun, Coleman Martin, William E. Holloway, Nils Mueller-Kronast, Joey D. English, Tim W. Malisch, Franklin A. Marden, Hormozd Bozorgchami, Andrew Xavier, Ansaar T. Rai, Michael T. Froehler, Aamir Badruddin, Thanh N. Nguyen, M. Asif Taqi & 13 others Michael G. Abraham, Vallabh Janardhan, Hashem Shaltoni, Roberta Novakovic, Albert J. Yoo, Alex Abou-Chebl, Peng R. Chen, Gavin W. Britz, Ritesh Kaushal, Ashish Nanda, Mohammad A. Issa, Raul G. Nogueira, Osama O. Zaidat

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Background Mechanical thrombectomy with stentretrievers 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.

Original languageEnglish (US)
Pages (from-to)224-229
Number of pages6
JournalJournal of NeuroInterventional Surgery
Volume8
Issue number3
DOIs
StatePublished - Mar 1 2016
Externally publishedYes

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United States National Aeronautics and Space Administration
Registries
Cerebral Infarction
National Institutes of Health (U.S.)
Tissue Plasminogen Activator
Stroke
Regression Analysis
Internal Carotid Artery
Thrombectomy
Basilar Artery
Stents
Diabetes Mellitus
Therapeutics
Catheters
Logistic Models
Equipment and Supplies

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Linfante, I., Starosciak, A. K., Walker, G. R., Dabus, G., Castonguay, A. C., Gupta, R., ... Zaidat, O. O. (2016). Predictors of poor outcome despite recanalization: A multiple regression analysis of the NASA registry. Journal of NeuroInterventional Surgery, 8(3), 224-229. https://doi.org/10.1136/neurintsurg-2014-011525

Predictors of poor outcome despite recanalization : A multiple regression analysis of the NASA registry. / Linfante, Italo; Starosciak, Amy K.; Walker, Gail R.; Dabus, Guilherme; Castonguay, Alicia C.; Gupta, Rishi; Sun, Chung Huan J.; Martin, Coleman; Holloway, William E.; Mueller-Kronast, Nils; English, Joey D.; Malisch, Tim W.; Marden, Franklin A.; 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; Yoo, Albert J.; Abou-Chebl, Alex; Chen, Peng R.; Britz, Gavin W.; Kaushal, Ritesh; Nanda, Ashish; Issa, Mohammad A.; Nogueira, Raul G.; Zaidat, Osama O.

In: Journal of NeuroInterventional Surgery, Vol. 8, No. 3, 01.03.2016, p. 224-229.

Research output: Contribution to journalArticle

Linfante, I, Starosciak, AK, Walker, GR, Dabus, G, Castonguay, AC, Gupta, R, Sun, CHJ, Martin, C, Holloway, WE, Mueller-Kronast, N, English, JD, Malisch, TW, Marden, FA, Bozorgchami, H, Xavier, A, Rai, AT, Froehler, MT, Badruddin, A, Nguyen, TN, Taqi, MA, Abraham, MG, Janardhan, V, Shaltoni, H, Novakovic, R, Yoo, AJ, Abou-Chebl, A, Chen, PR, Britz, GW, Kaushal, R, Nanda, A, Issa, MA, Nogueira, RG & Zaidat, OO 2016, 'Predictors of poor outcome despite recanalization: A multiple regression analysis of the NASA registry', Journal of NeuroInterventional Surgery, vol. 8, no. 3, pp. 224-229. https://doi.org/10.1136/neurintsurg-2014-011525
Linfante, Italo ; Starosciak, Amy K. ; Walker, Gail R. ; Dabus, Guilherme ; Castonguay, Alicia C. ; Gupta, Rishi ; Sun, Chung Huan J. ; Martin, Coleman ; Holloway, William E. ; Mueller-Kronast, Nils ; English, Joey D. ; Malisch, Tim W. ; Marden, Franklin A. ; 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 ; Yoo, Albert J. ; Abou-Chebl, Alex ; Chen, Peng R. ; Britz, Gavin W. ; Kaushal, Ritesh ; Nanda, Ashish ; Issa, Mohammad A. ; Nogueira, Raul G. ; Zaidat, Osama O. / Predictors of poor outcome despite recanalization : A multiple regression analysis of the NASA registry. In: Journal of NeuroInterventional Surgery. 2016 ; Vol. 8, No. 3. pp. 224-229.
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title = "Predictors of poor outcome despite recanalization: A multiple regression analysis of the NASA registry",
abstract = "Background Mechanical thrombectomy with stentretrievers 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.",
author = "Italo Linfante and Starosciak, {Amy K.} and Walker, {Gail R.} and Guilherme Dabus and Castonguay, {Alicia C.} and Rishi Gupta and Sun, {Chung Huan J.} and Coleman Martin and Holloway, {William E.} and Nils Mueller-Kronast and English, {Joey D.} and Malisch, {Tim W.} and Marden, {Franklin A.} and Hormozd Bozorgchami and Andrew Xavier and Rai, {Ansaar T.} and Froehler, {Michael T.} and Aamir Badruddin and Nguyen, {Thanh N.} and Taqi, {M. Asif} and Abraham, {Michael G.} and Vallabh Janardhan and Hashem Shaltoni and Roberta Novakovic and Yoo, {Albert J.} and Alex Abou-Chebl and Chen, {Peng R.} and Britz, {Gavin W.} and Ritesh Kaushal and Ashish Nanda and Issa, {Mohammad A.} and Nogueira, {Raul G.} and Zaidat, {Osama O.}",
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TY - JOUR

T1 - Predictors of poor outcome despite recanalization

T2 - A multiple regression analysis of the NASA registry

AU - Linfante, Italo

AU - Starosciak, Amy K.

AU - Walker, Gail R.

AU - Dabus, Guilherme

AU - Castonguay, Alicia C.

AU - Gupta, Rishi

AU - Sun, Chung Huan J.

AU - Martin, Coleman

AU - Holloway, William E.

AU - Mueller-Kronast, Nils

AU - English, Joey D.

AU - Malisch, Tim W.

AU - Marden, Franklin A.

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 - Yoo, Albert J.

AU - Abou-Chebl, Alex

AU - Chen, Peng R.

AU - Britz, Gavin W.

AU - Kaushal, Ritesh

AU - Nanda, Ashish

AU - Issa, Mohammad A.

AU - Nogueira, Raul G.

AU - Zaidat, Osama O.

PY - 2016/3/1

Y1 - 2016/3/1

N2 - Background Mechanical thrombectomy with stentretrievers 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.

AB - Background Mechanical thrombectomy with stentretrievers 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.

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