Revascularization and functional outcomes after mechanical thrombectomy: an update to key metrics

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  • 1 Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; and
  • 2 Department of Neurosurgery, University of Washington, Seattle, Washington
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OBJECTIVE

The advent of mechanical thrombectomy (MT) has become an effective option for the treatment of acute ischemic stroke in addition to tissue plasminogen activator (tPA). With recent advances in device technology, MT has significantly altered the hospital course and functional outcomes of stroke patients. The authors’ goal was to establish the most up-to-date reperfusion and functional outcomes with the evolution of MT technology.

METHODS

The authors conducted a retrospective study of 403 patients who underwent MT for ischemic stroke at their institution from 2010 to 2017. They collected data on patient comorbidities, National Institutes of Health Stroke Scale (NIHSS) score on arrival, tPA administration, revascularization outcomes, and functional outcomes on discharge.

RESULTS

In 403 patients, the mean NIHSS score on presentation was 15.8 ± 6.6, with 195 (48.0%) of patients receiving tPA prior to MT. Successful reperfusion (thrombolysis in cerebral infarction score 2B or 3) was achieved in 84.4%. Hemorrhagic conversion with significant mass effect was noted in 9.9% of patients. The median lengths of ICU and hospital stay were 3.0 and 7.0 days, respectively. Functional independence (modified Rankin Scale score 0–2) was noted in 125 (31.0%) patients, while inpatient mortality occurred in 43 (10.7%) patients.

CONCLUSIONS

As MT has established acute ischemic stroke as a neurosurgical disease, there is a pressing need to understand the hospital course, hospital- and procedure-related complications, and outcomes for this new patient population. The authors provide a detailed account of key metrics for MT with the latest device technology and identify the predictors of unfavorable outcomes and inpatient mortality.

ABBREVIATIONS CHF = congestive heart failure; DVT = deep vein thrombosis; LOS = length of stay; mRS = modified Rankin Scale; MT = mechanical thrombectomy; NIHSS = National Institutes of Health Stroke Scale; TICA = thrombolysis in cerebral infarction; tPA = tissue plasminogen activator.

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Contributor Notes

Correspondence M. Reid Gooch: Thomas Jefferson University and Jefferson Medical College, Philadelphia, PA. reid.gooch@jefferson.edu.

INCLUDE WHEN CITING Published online September 13, 2019; DOI: 10.3171/2019.6.JNS183649.

Disclosures Dr. Tjoumakaris: consultant for Medtronic. Dr. Gooch: consultant for Minnetronix.

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