ICH, high NIHSS score predict mortality in stroke after reperfusion

Some acute ischaemic stroke patients treated with mechanical thrombectomy remain at risk of death despite successful reperfusion, a study reports. Among these patients, symptomatic intracranial haemorrhage (ICH) and high post-thrombectomy National Institutes of Health Stroke Scale (NIHSS) score strongly predict 90-day mortality.

This study used data from DIRECT-MT* and included 622 consecutive acute ischaemic stroke patients who were treated with endovascular thrombectomy with or without intravenous alteplase. Of these, 510 (82.0 percent) achieved successful reperfusion while 115 (18.5 percent) died within 90 days.

On univariate analysis, the risk of mortality was high among patients aged ≥70 years, with history of diabetes mellitus, had NIHSS score of ≥17 on admission, NIHSS score of ≥11 after thrombectomy (24±6 hours), Alberta Stroke Program Early Computed Tomography Score (ASPECTS) <9, glucose level of ≥130 mg/dL at hospital arrival, internal carotid artery occlusion, embolization into a new territory, and symptomatic ICH. On the other hand, smokers had a lower risk of mortality.

In multivariable logistic regression models, the following factors emerged as significant predictors of 90-day mortality: smoking (odds ratio [OR], 0.38, 95 percent confidence interval [CI], 0.17–0.83; p=0.015), NIHSS score on admission ≥17 (OR, 3.14, 95 percent CI, 1.77–5.55; p<0.001), glucose level at hospital arrival ≥130 mg/dL (OR, 2.54, 95 percent CI, 1.51–4.27; p<0.001), symptomatic ICH (OR, 11.70, 95 percent CI, 4.74–28.89; p<0.001), and NIHSS score after thrombectomy (24±6 hours) ≥11 (OR, 12.04, 95 percent CI, 5.09–28.46; p<0.001).

More studies are needed to validate the association between smoking and lower risk of mortality.

*Direct Intra-arterial thrombectomy in order to Revascularize AIS patients with large vessel occlusion Efficiently in Chinese Tertiary hospitals: a Multicentre randomized clinical Trial