Türk Beyin Damar Hast Derg. 2023; 29(1): 28-37 | DOI: 10.5505/tbdhd.2023.03779

Predictors of good clinical outcome in acute ischemic stroke patients after mechanical thrombectomy

Serhan Yýldýrým
Health Sciences University, Derince Training and Research Hospital, Neurology Clinic, Kocaeli, Türkiye

INTRODUCTION: Mechanical thrombectomy(MT) is recommended treatment for acute ischemic stroke patients due to large vessel occlusions. Despite successful recanalization, patients may not have a good clinical outcome. This study aims to identify the predictors of good clinical outcome in acute stroke patients treated with MT.
METHODS: This study was designed retrospectively. Acute ischemic stroke patients treated with mechanical thrombectomy because of the internal carotid artery or M1 segment of the middle cerebral artery occlusion between 2018 and 2022 were included in this study. mRS score ≤2 on the 90th day was defined as a good clinical outcome.
RESULTS: A total of 110 patients were treated with MT. Good clinical outcomes occurred in 56 (50.9%) of patients. Good clinical outcome group had decreased levels of age(p<0.000), glucose(p=0.018), neutrophil-lymphocyte ratio(NLR) (p=0.010), C-reactive peptide(CRP) (p=0.004) and diastolic blood pressure(DBP) (p=0.009). The poor clinical outcome group had increased NIHHS scores at onset(p<0.001) and 24th hour(p<0.001). The good clinical outcome had higher rates of good collaterals(p<0.001) and successful recanalization(p<0.001). The rate of intracerebral hemorrhage was significantly low in the good clinical outcome group (p=0.007).
DISCUSSION AND CONCLUSION: Good collaterals and successful recanalization are predictors of good clinical outcomes. ICH is a predictor factor of poor clinical outcomes. Younger age, decreased glucose, NLR, CRP, NIHSS score at onset and 24th hour, DBP, and procedure time are other predictors of good clinical outcome.

Keywords: Good clinical outcome, ischemic stroke, mechanical thrombectomy, predictors.

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Mekanik trombektomi yapýlan akut iskemik inme hastalarýnda iyi klinik sonucu belirleyen faktörler

Serhan Yýldýrým
Saðlýk Bilimleri Üniversitesi, Derince Eðitim ve Araþtýrma Hastanesi, Nöroloji Kliniði, Kocaeli

GÝRÝÞ ve AMAÇ: Mekanik trombektomi (MT), büyük damar týkaniklýðýna baðlý iskemik inme tedavisinin en etkili yöntemidir. Baþarýlý rekanalizasyona raðmen bazý hastalarda iyi klinik sonuç elde edilememektedir. Bu çalýþmanýn amacý akut iskemik inmeli hastalarda MT sonrasý iyi klinik sonuç üzerine etkili faktörleri saptamaktýr.
YÖNTEM ve GEREÇLER: 2018-2021 yýllarý arasýnda mekanik trombektomi yapýlan hastalarýn dosyalarý retrospektif olarak tarandý. Ýnternal karotid arter ya da orta serebral arterin M1 segment oklüzyonu olan ve mekanik trombektomi yapýlan hastalar çalýþmaya dahil edildi. Modifiye Rankin Skalasý skorunun 0-2 arasýnda olmasý iyi klinik sonuç olarak tanýmlandý.
BULGULAR: Toplam 110 hasta çalýþmaya dahil edildi. Ýyi klinik sonuç 56 (%50,9) hastada izlendi. Ýyi klinik sonuç grubunda daha düþük yaþ (P=0,000), kan glukozu (p=0,018), nötrofil-lenfosit oraný (NLR) (p=0,010), C-reaktif peptid (CRP) (p=0,004) ve diastolik kan basýncý (p=0,009) izlendi. Kötü klinik sonuç grubunda ise daha yüksek giriþ ve 24. saat NIHSS skoru izlendi (sýrasýyla p=0,000, p=0,000). Ýyi klinik sonuç grubunda daha fazla iyi kollateral (p=0,000) ve baþarýlý rekanalizasyon (p=0,000) oranlarý izlendi. Ýntraserebral kanama iyi klinik sonuç grubunda daha düþük oranda izlendi(p=0,007).
TARTIÞMA ve SONUÇ: Ýyi kollateral dolaþým ve baþarýlý rekanalizasyon iyi klinik sonucun en önemli belirleyicileridir. Ýntrasereral kanama ise kötü klinik sonuç ile iliþkilidir. Genç yaþ, düþük kan glikozu, NLR, CRP, giriþteki ve 24. saatteki NIHSS skorlarý, diastolik kan basýncý ve iþlem süresi iyi klinik sonucun diðer belirleyici faktörleridir.

Anahtar Kelimeler: Ýyi klinik sonuç, iskemik inme, mekanik trombektomi, prediktörler.

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