FACTORS ASSOCIATED WITH UNFAVOURABLE OUTCOME AFTER SUCCESSFUL THROMBECTOMY IN LARGE VESSEL ISCHEMIC STROKE

Background and Aims: Despite modern endovascular treatment, the burden of poor outcomes in acute ischemic stroke patients remains high even after successful endovascular thrombectomy (EVT). In this study we attempt to identify the potential predictors of such outcomes.
Methods: 404 large vessel ischemic stroke patients treated with EVT at University Hospital Stroke Center, from 2015 to 2024 were selected based on successful TICI scores (2b or 3). Long-term outcomes were categorized as favourable (mRS 0–3) or unfavourable (mRS 4–6) at 90 days post-procedure.
Results: 10 predictors of unfavourable outcomes were proposed for univariate analysis: time to needle, wake-up stroke, admission NIHSS, EVT duration, number of EVT passes, bridging thrombolysis, gender, platelet count, diabetes, hypertension.
Significant predictors identified in unfavourable vs. favourable outcomes were:
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Time to needle (TTN) (median 280min [IQR 210-359] vs. 240min [IQR 192-300] p<0.001);
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Admission NIHSS (median 18 [IQR 14-20] vs. 14 [IQR 9-17]; p<0.001);
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EVT duration (median 40min [IQR 24-59] vs. 30min [IQR 20-45]; p<0.001);
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Number of EVT passes (1 vs. >3; p<0.001).
Following multivariate analysis, independent predictors of unfavourable outcomes were identified:
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NIHSS at admission (OR = 1.180 per point; p<0.001, 95%CI 1.118-1.246)
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EVT procedure duration (OR = 1.021 per minute; p = 0.001, 95%CI 1.009-1.033)
The logistic regression model achieved 71.0% classification accuracy, with a sensitivity of 69.5%, specificity of 72.4%, and AUC of 0.776.
Conclusion: Unfavorable outcomes following EVT, despite successful recanalization are significantly predicted by: longer TTN, more passes during EVT procedure and independently associated with NIHSS at admission and EVT procedure duration. Recognizing these predictors can improve the patient management approaches.