Prediction of death after endovascular thrombectomy in the extended window: a secondary analysis of DEFUSE 3 '
| Autor: | Adam de Havenon, Guilherme José Agnoletto, Matthew D Alexander, Ka-Ho Wong, Philipp Taussky, Ramesh Grandhi, Gregory W. Albers |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Article Brain Ischemia 03 medical and health sciences 0302 clinical medicine Patient age Internal medicine Diabetes mellitus Secondary analysis medicine Humans 030212 general & internal medicine Stroke Aged Thrombectomy business.industry Endovascular Procedures Regression analysis General Medicine medicine.disease Clinical trial Treatment Outcome Female Surgery Neurology (clinical) Risk of death business 030217 neurology & neurosurgery Cohort study |
| Zdroj: | J Neurointerv Surg |
| ISSN: | 1759-8486 1759-8478 |
| DOI: | 10.1136/neurintsurg-2020-016548 |
| Popis: | BackgroundThe Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3 (DEFUSE 3) clinical trial assessed the use of endovascular thrombectomy (EVT) during the period 6–16 hours after last normal in selected patients. This is a secondary cohort analysis of the DEFUSE 3 data assessing potential predictive variables for mortality in the EVT-treated patients.MethodsThe primary outcome was death within 90 days. Patients who died and those who did not were compared statistically. We developed a predictive score using preprocedural variables that were statistically predictive of death in univariate regression analysis (PResultsOf the 182 patients in the DEFUSE 3 study, 92 (mean age 69 years; 50% male) met our inclusion criteria, and 15.2% of these patients met the primary outcome. Patient age, baseline National Institutes of Health Stroke Scale (NIHSS) score, wake-up stroke, statin use, and history of diabetes were statistically associated with death. Statin use did not improve the prediction score so was excluded. Thus, our model included four predictors, with one point each given for age >75 years, NIHSS ≥20, wake-up stroke, and diabetes, yielding low (0–1), moderate (2), and high (3–4) risk of death. In the low-risk, moderate-risk, and high-risk categories, 2/52 (3.9%), 3/23 (13.0%), and 9/17 (52.9%) of patients died, respectively (PConclusionsDespite selective inclusion criteria and overwhelming benefit for EVT, a substantial number of EVT patients in DEFUSE 3 died. The preprocedural variables age, NIHSS, wake-up stroke, and diabetes may predict this risk. Our predictive score provides a basis for future research to determine which factors influence lethal outcome after EVT. |
| Databáze: | OpenAIRE |
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