Predicting clinical outcomes in patients with ischemic stroke following successful thrombectomy: clinical, neuroradiological, and periprocedural predictors

Endovascular thrombectomy (EVT) is a highly effective method of restoring blood flow in patients with large cerebral artery occlusion. However, it is not uncommon for neurological deficits to persist or even worsen despite successful recanalization.

Objective: to identify factors associated with good and satisfactory functional recovery (mRS 0–3) following successful EVT (defined as achieving TICI 2b/3 reperfusion).

Material and methods. This retrospective analysis included 90 patients with ischemic stroke in the carotid territory who underwent EVT with achieved TICI 2b/3 reperfusion. The prognostic value of clinical, neuroradiological, and periprocedural factors was assessed.

Results. Univariate logistic regression analysis identified several predictors of good or satisfactory outcome after EVT: the degree of neurological disturbances (National Institutes of Health Stroke Scale, NIHSS score) on admission (OR 0.87; 95% CI 0.79–1.02; p=0.005), NIHSS at 24 hours post-EVT (OR 0.70; 95% CI 0.60–0.81; p<0.0005), presence of T-occlusion of the internal carotid artery (OR 0.25; 95% CI 0.06–0.97; p=0.045), hemorrhagic transformation (OR 0.10; 95% CI 0.03–0.34; p<0.0005), the early CT ischemic signs volume (OR 0.97; 95% CI 0.94–0.99; p<0.001), volume with rCBF <30% (OR 0.91; 95% CI 0.87–0.96; p<0.0005), infarct core volume by day 3 (OR 0.95; 95% CI 0.92–0.97; p<0.0005), systemic thrombolysis (OR 5.79; 95% CI 1.24–26.96; p<0.0005), ASPECTS score (OR 2.43; 95% CI 1.67–3.53; p<0.0005), eASPECTS score (OR 1.53; 95% CI 1.18–2.0; p=0.002), T_max/rCBF mismatch (OR 1.09; 95% CI 1.03–1.16; p=0.002). In multivariate logistic regression, three independent predictors of good or satisfactory functional outcome were identified: ASPECTS score, number of thrombectomy passes, and hemorrhagic transformation (model sensitivity – 95.7%, specificity – 70.0%).

Conclusion: The clinical outcome of ischemic stroke following successful recanalization is determined by a combination of factors reflecting both the initial state of brain tissue and the complexity of the procedure, as well as the occurrence of reperfusion-related postoperative complications.

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