Predictors of Mortality in Acute Ischemic Stroke Intervention: Analysis of the North American Solitaire Acute Stroke Registry.

By:Linfante I1, Walker GR2, Castonguay AC2, Dabus G2, Starosciak AK2, Yoo AJ2, Abou-Chebl A2, Britz GW2, Marden FA2, Alvarez A2, Gupta R2, Sun CH2, Martin C2, Holloway WE2, Mueller-Kronast N2, English JD2, Malisch TW2, Bozorgchami H2, Xavier A2, Rai AT2, Froehler MT2, Badruddin A2, Nguyen TN2, Taqi MA2, Abraham MG2, Janardhan V2, Shaltoni H2, Novakovic R2, Chen PR2, Kaushal R2, Nanda A2, Issa MA2, Nogueira RG2, Zaidat OO2.|Date: August 04, 2015|Source: Stroke. 2015 Aug;46(8):2305-8. doi: 10.1161/STROKEAHA.115.009530. Epub 2015 Jul 9.

Abstract

BACKGROUND AND PURPOSE:

Failure to recanalize predicts mortality in acute ischemic stroke. In the North American Solitaire Acute Stroke registry, we investigated parameters associated with mortality in successfully recanalized patients.

METHODS:

Logistic regression was used to evaluate baseline characteristics and recanalization parameters for association with 90-day mortality. A multivariable model was developed based on backward selection with retention criteria of P<0.05 from factors with at least marginal significance (P≤0.10), then refit to minimize the number of excluded cases (missing data).

RESULTS:

Successfully recanalized patients had lower mortality (25.2% [59/234] versus 46.9% [38/81] P<0.001). There was no difference in symptomatic intracranial hemorrhage between patients with successful versus failed recanalization (9% [21/234] versus 14% [11/79]; P=0.205). However, mortality was significantly higher in patients with symptomatic intracranial hemorrhage (72% [23/32] versus 26% [73/281]; P<0.001). Proximal occlusion (internal carotid artery or vertebrobasilar), initial National Institutes of Health Stroke Scale≥18, use of rescue therapy (P<0.05), and 3+ passes (P<0.10) were associated with mortality in recanalized patients. In the multivariate model with good predictive power (c index=0.72), proximal occlusion, initial National Institutes of Health Stroke Scale≥18, and use of rescue therapy remained significant independent predictors of 90-day mortality.

CONCLUSIONS:

Failure to recanalize and presence of symptomatic intracranial hemorrhage resulted in increased mortality. Despite successful recanalization, proximal occlusion, high National Institutes of Health Stroke Scale, and need for rescue therapy were predictors of mortality.