Comprehensive Meta-Analysis of Futile Recanalization in Acute Ischemic Stroke Patients Undergoing Endovascular Thrombectomy: Prevalence, Factors, and Clinical Outcomes

Life, Journal Year: 2023, Volume and Issue: 13(10), P. 1965 - 1965

Published: Sept. 26, 2023

Background: Futile recanalization (FR) continues to raise concern despite the success of endovascular thrombectomy (EVT) in acute ischemic stroke (AIS). Understanding prevalence FR and identifying associated factors are crucial for refining patient prognoses optimizing management strategies. Objectives: This study aims comprehensively assess pooled FR, explore diverse connected with establish association long-term clinical outcomes among AIS patients undergoing EVT. Materials Methods: Incorporating studies focusing on following EVT patients, we conducted a random-effect meta-analysis its various imaging risk linked FR. Summary estimates were compiled heterogeneity was explored. Results: Our comprehensive meta-analysis, involving 11,700 EVT, revealed significant at 51%, range 48% 54% (Effect Size [ES]: 51%; 95% Confidence Interval [CI]: 48–54%; z = 47.66; p < 0.001). Numerous demonstrated robust correlations including atrial fibrillation (Odds Ratio [OR]: 1.39, CI 1.22 1.59; 0.001), hypertension (OR 1.65, 1.41 1.92; diabetes mellitus 1.71, 1.47 1.99; previous or transient attack 1.298, 1.06 0.012), prior anticoagulant usage 1.33, 1.08 1.63; 0.007), cardioembolic strokes 1.34, 1.10 0.003), general anesthesia 1.53, 1.35 1.74; Conversely, exhibited reduced likelihoods smoking 0.66, 0.57 0.77; good collaterals 0.33, 0.23 0.49; male sex 0.87, 0.77 0.97; 0.016), intravenous thrombolysis (IVT) 0.75, 0.66 0.86; strongly increasing age (standardized mean difference [SMD] 0.49, 0.42 0.56; 0.0001), baseline systolic blood pressure (SMD 0.20, 0.13 0.27; National Institute Health Stroke Severity Score CI: 0.65 onset-to-treatment time 0.217, 0.30; onset-to-recanalization 0.38, 0.19; 0.57; glucose 0.31, 0.22 0.41; while displaying negative Alberta Program Early CT (ASPECTS) −0.37, −0.46 −0.27; Regarding outcomes, significantly increased odds symptomatic intracranial hemorrhages 7.37, 4.89 11.12; hemorrhagic transformations 2.98, 2.37 3.75; 90-day mortality 19.24, 1.57 235.18; 0.021). Conclusions: The substantial standing approximately warrants consideration. These findings underscore complexity highlight importance tailoring strategies based individual profiles.

Language: Английский

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Stress hyperglycemia increases short-term mortality in acute ischemic stroke patients after mechanical thrombectomy

Diabetology & Metabolic Syndrome, Journal Year: 2024, Volume and Issue: 16(1)

Published: Jan. 31, 2024

Abstract Background and purpose Glucose-to-glycated hemoglobin ratio (GAR) is considered a more reliable marker of stress hyperglycemia by correcting for basal blood glucose levels. This study aimed to investigate the extent which GAR associated with 3 month 1 year all-cause mortalities in patients acute ischemic stroke (AIS) undergoing mechanical thrombectomy (MT). Methods We retrospectively followed 553 AIS who underwent MT. The degree was quantified as GAR, defined fasting plasma (mmol/L)/hemoglobin A1c (HbA1c) (%) on second day after admission. According quartiles, were further categorized into four groups (group 1-group 4). assessed association between mortalities, clinical outcomes during hospitalization function at months. associations analyzed using Cox proportional-hazards model, while other multiple logistic regression analysis. Results follow-up lasted median 18 months (range 0–66 months). mortality rate 9.58% (n = 53) 18.62% 103). Kaplan–Meier analysis revealed significant inverse relationship ( P < 0.001). In model months, compared group1, group 4 increase risk (hazard [HR] 4.11, 95% confidence interval [CI] 1.41–12.0, 0.01) adjusting potential covariates. On multivariate analysis, strongly an increased poor outcome. Conclusions Stress hyperglycemia, higher functional undergo Furthermore, may contribute improving predictive efficiency MT, especially short-term mortality.

Language: Английский

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Stress hyperglycemia is associated with futile recanalization in patients with anterior large vessel occlusion undergoing mechanical thrombectomy

European Stroke Journal, Journal Year: 2024, Volume and Issue: 9(3), P. 613 - 622

Published: April 16, 2024

Introduction: Mechanical thrombectomy (MT) is the standard treatment for acute ischemic stroke (AIS) due to anterior large vessel occlusion (LVO). Despite successful recanalization, some patients remain disabled after 3 months. Mechanisms that can cause futile recanalization (FR) are still largely unknown. We investigated if stress hyperglycemia might be associated with FR. Patients and methods: This a retrospective analysis of consecutive treated in four participating centers between January 2021 December 2022. According modified Rankin scale (mRS) status at months, were divided into two groups: FR, mRS score >2, useful (UR), ⩽2. Stress was estimated by glucose-to-glycated hemoglobin ratio (GAR) index. Results: A total 691 subjects included. At 403 (58.3%) included FR group, while remaining 288 (41.7%) UR group. multivariate analysis, variables independently following: age (OR 1.04, 95% CI 1.02–1.06, p < 0.001), GAR index 1.08, 1.03–1.14, = 0.003), NIHSS admission 1.16, 1.11–1.22; procedure length 1.01, 1.00–1.02; 0.009). observed model combining age, index, admission, had good predictive accuracy (AUC 0.78, 0.74–0.81). Conclusions: predicts MT. Further studies should explore managing may reduce recanalization. Additionally, we recommend paying close attention AIS greater than 24.8 who exhibit high risk

Language: Английский

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The effects of admission hyperglycemia and diabetes mellitus on mechanical thrombectomy outcomes: A systematic review and meta-analysis

Interventional Neuroradiology, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 17, 2025

The impact of certain comorbidities on mechanical thrombectomy (MT) outcomes remains largely unexplored. Diabetes mellitus (DM) and admission hyperglycemia have been associated with poor clinical for patients treated MT. In this study, we sought to investigate the effects DM MT outcomes. Following PRISMA guidelines, a systematic literature search was conducted in Medline, Embase, Scopus, Web Science databases. Data regarding successful recanalization (modified Thrombolysis Cerebral Infarction [mTICI] ≥2b), functional independence Rankin Scale [mRS] 0-2), excellent (mRS 0-1), symptomatic intracranial hemorrhage (sICH), mortality were extracted from included studies. pooled odds ratios (ORs) their corresponding 95% confidence intervals (CIs) calculated using random model. Twenty-one studies comprising 9708 included. A total 2311 (24%) had history DM, 2026 (21%) hyperglycemia. Admission significantly lower mTICI ≥2b (OR = 0.7, CI 0.55-0.89), mRS 0-2 0.47, 0.41-0.53), 0-1 0.43, 0.34-0.55) as compared normoglycemic state. Patients higher rates sICH 2.05, 1.66-2.54) 1.99, 1.58-2.52) than patients. high 1.74, 1.31-2.3) 0.60, 0.48-0.76) sensitivity analyses. Our results indicate that blood glucose levels can negatively affect Further research should focus optimizing these

Language: Английский

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Stress Hyperglycemia Could Influence Futile Recanalization in Patients Who Undergo Mechanical Thrombectomy for Stroke Caused by Large Vessel Occlusion

World Neurosurgery, Journal Year: 2025, Volume and Issue: 195, P. 123697 - 123697

Published: Feb. 19, 2025

Mechanical thrombectomy (MT) has become the standard treatment for acute ischemic stroke caused by large vessel occlusion (LVO). Despite successful recanalization, approximately one-half of patients do not achieve a favorable outcome, which is known as "futile recanalization" (FR). The present study aimed to explore association between stress hyperglycemia and FR after MT. Data from 224 eligible with LVO, who underwent MT at authors' hospital January 2015 December 2023, were retrospectively reviewed. Patients divided into group non-FR groups according functional independence 3 months modified Rankin scale. Factors influencing identified using multivariate regression receiver operating characteristic (ROC) curve analyses. was observed in 40 (38.4%) 104 fulfilled inclusion criteria. Multivariable analysis revealed that older age (odds ratio [OR] 1.09 [95% confidence interval (CI) 1.03-1.15]; P=0.001), an increased number passes (OR 1.57 CI 1.03-2.40]; P=0.034), greater (SHR) 16.0 1.49-172.8]; P=0.021) independently associated ROC model combining age, SHR, Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Scores, procedure duration, systolic blood pressure, (area under curve, 0.83, [P<0.01]) accurate. Results this passes, SHR LVO.

Language: Английский

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The prognostic value of the stress hyperglycemia ratio for all-cause mortality in stroke patients with diabetes or prediabetes

Journal of Diabetes and its Complications, Journal Year: 2025, Volume and Issue: 39(4), P. 108979 - 108979

Published: March 6, 2025

Language: Английский

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Novel Risk Score to Predict Poor Outcome After Endovascular Treatment in Anterior Circulation Occlusive Acute Ischemic Stroke

Journal of the American Heart Association, Journal Year: 2025, Volume and Issue: unknown

Published: April 10, 2025

Background We aimed to develop and validate a prognostic score predict outcomes after endovascular treatment in acute ischemic stroke. Methods The was developed based on the ACTUAL (Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke) registry. validation cohort derived from Captor trial. Independent predictors of poor outcome were obtained least absolute shrinkage selection operator regression multivariable logistic regression. Corresponding coefficients used generate point scoring system. area under receiver operating characteristic curve Hosmer–Lemeshow goodness‐of‐fit test assess model discrimination calibration. predictive properties validated discriminative power compared with other tools. Results A 17‐point Age, Collateral Status, Blood glucose, Alberta Stroke Program Early Computed Tomography Score, National Institutes Health Scale scale set independent predictors, including age, admission score, Score initial computed tomography scan, blood collateral status. showed good derivation (area curve, 0.79 [95% CI, 0.75–0.82]) cohorts 0.77 0.70–0.84]). well calibrated (Hosmer–Lemeshow test) ( P =0.57) =0.75). Conclusions is valid tool predicting may be useful stroke anterior circulation large vessel occlusions.

Language: Английский

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Triglyceride-glucose index predicts death in patients with stroke younger than 65

Frontiers in Neurology, Journal Year: 2023, Volume and Issue: 14

Published: Aug. 3, 2023

Background The triglyceride-glucose index (TGI), a reliable surrogate indicator of insulin resistance (IR), has been proven to be predictor the incidence ischemic stroke. role TGI in predicting outcomes stroke patients remains controversial. Susceptibility IR-related diseases varies among different ages. study aims evaluate predictive value levels on clinical with Method This was retrospective cohort including Department Neurology at West China Hospital. calculated as ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. were subdivided into 3 tertiles according levels. Multivariate logistic regression analyses conducted estimate association between and post-stroke whole patients, younger (&lt;65), older (&gt;=65). included death unfavorable functional outcome (modified Rankin scale score 3–6) 12 months after Results A total 3,704 (men, 65.08%, mean age, 61.44 ± 14.15; women 34.92%, 65.70 13.69) enrolled this study. not associated month or patients. Patients higher (T2 T3) had risk than those lower (T1) group vs. T1: OR 2.64, 95% CI 1.03–6.79, p = 0.043; T3 2.69, 1.00–7.10, 0.049) but group. Additionally, Kaplan–Meier analysis illustrated that significantly highest ( for log-rank test 0.028) There an interactive effect age interaction 0.013) 0.027). However, Conclusion Elevated independently predicts under 65 Regulating is expected approach enhance prognosis young individuals affected by

Language: Английский

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Prognostic Determinants of Anterior Large Vessel Occlusion in Acute Stroke in Elderly Patients

Geriatrics, Journal Year: 2024, Volume and Issue: 9(1), P. 13 - 13

Published: Jan. 15, 2024

This study investigated prognostic factors in elderly patients (80 years and older) undergoing mechanical thrombectomy (MT) for anterior circulation large vessel occlusion (LVO) acute stroke treatment. Of 59 cases, 47.5% achieved a favorable outcome (mRS ≤ 3) at three months, with mortality rate of 20.3%. Factors associated better outcomes included younger age, lower admission National Institute Health Stroke Scale (NIHSS) scores, N-terminal pro-brain natriuretic peptide (NT-proBNP) D-dimer levels, the presence first pass effect (FPE), successful recanalization. However, logistic regression showed that only NIHSS scores were significantly correlated outcomes. In addition, this suggests NT-proBNP levels could potentially serve as indicators LVO MT.

Language: Английский

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Predictive factors of poor outcome and mortality among anterior ischaemic stroke patients despite successful recanalisation in China: a secondary analysis of the CAPTURE trial

BMJ Open, Journal Year: 2023, Volume and Issue: 13(12), P. e078917 - e078917

Published: Dec. 1, 2023

Objectives This work aimed to analyse the risk factors for poor outcomes and mortality among patients with anterior large vessel occlusion (LVO) ischaemic stroke, despite successful recanalisation. Setting participants study conducted a secondary analysis who underwent recanalisation in CAPTURE trial. The trial took place between March 2018 September 2020 at 21 sites China. enrolled had an acute stroke aged 18–80 years LVO circulation. Interventions Thrombectomy was immediately performed using Neurohawk or Solitaire FR after randomisation Rescue treatment available severe residual stenosis caused by atherosclerosis. Primary outcome measures primary goal predict 90-day survival within 90 days post-thrombectomy. Univariate analysis, χ 2 test Fisher’s exact test, each selected factor. Subsequently, multivariable on significant (p≤0.10) identified through univariate backward selection logistic regression approach. Results Among 207 recruited patients, 79 (38.2%) exhibited clinical outcomes, 26 (12.6%) died Multivariate revealed that following were significantly associated survival: age ≥67 years, internal carotid artery (ICA) (compared middle cerebral (MCA) occlusion), initial National Institutes of Health Stroke Scale (NIHSS) score ≥17 final modified Thrombolysis Cerebral Infarction (mTICI) 2b mTICI 3). Additionally, post-thrombectomy: NIHSS ≥17, ICA MCA occlusion) more than one pass. Conclusions Age, score, site, number passes can be independently used Trial registration NCT04995757 .

Language: Английский

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