Predictive factors of poor outcome and mortality among anterior ischaemic stroke patients despite successful recanalisation in China: a secondary analysis of the CAPTURE trial

Guangwen Li; Yujie Sun; Tonghui Liu; Pengfei Yang; Ya Peng; Wenhuo Chen; Liyong Zhang; Jianfeng Chu; Dong Kuai; Zibo Wang; Wei Wu; Yun Xu; Bin Zhou; Yu Geng; Congguo Yin; Jiang Li; Ming Wang; Xiaoxiang Peng; Yaping Xiao; Minghua Li; Xianjun Zhang; Peng Liu; Naidong Wang; Yong Zhang

doi:10.1136/bmjopen-2023-078917

Predictive factors of poor outcome and mortality among anterior ischaemic stroke patients despite successful recanalisation in China: a secondary analysis of the CAPTURE trial

BMJ Open. 2023 Dec 9;13(12):e078917. doi: 10.1136/bmjopen-2023-078917.

Authors

Guangwen Li¹, Yujie Sun¹, Tonghui Liu¹, Pengfei Yang², Ya Peng³, Wenhuo Chen⁴, Liyong Zhang⁵, Jianfeng Chu⁶, Dong Kuai⁷, Zibo Wang⁸, Wei Wu⁹, Yun Xu¹⁰, Bin Zhou¹¹, Yu Geng¹², Congguo Yin¹³, Jiang Li¹⁴, Ming Wang¹⁵, Xiaoxiang Peng¹⁶, Yaping Xiao¹⁷, Minghua Li¹⁸, Xianjun Zhang¹, Peng Liu¹, Naidong Wang¹, Yong Zhang¹⁹

Affiliations

¹ Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China.
² Neurovascular Center, Changhai Hospital, Naval Military Medical University, Shanghai, China.
³ Department of Neurosurgery, Changzhou First People's Hospital, Changzhou, Jiangsu, China.
⁴ Department of Neurology, Zhangzhou Hospital Affiliated to Fujian Medical University, Zhangzhou, China.
⁵ Department of Neurosurgery, Liaocheng People's Hospital Brain Hospital, Liaocheng, Shandong, China.
⁶ Department of Neurology, The First People's Hospital of Jining City, Jining, China.
⁷ Department of Neurosurgery, Shanxi Provincial Cardiovascular Hospital, Taiyuan, China.
⁸ Department of Neurointervention, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
⁹ Department of Neurology, Qilu Hospital of Shandong University, Jinan, Shandong, China.
¹⁰ Department of Neurology, Nanjing Gulou Hospital, Nanjing, China.
¹¹ Department of Neurointervention, Cerebrovascular Disease Center, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, China.
¹² Department of Neurology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China.
¹³ Department of Neurology, Hangzhou First People's Hospital, Hangzhou, Zhejiang, China.
¹⁴ Department of Neurosurgery, The Second Affiliated Hospital of Air Force Military Medical University, Xi'an, China.
¹⁵ Department of Neurointervention, Nanyang Second People's Hospital, Nanyang, China.
¹⁶ Department of Neurology, The Third People's Hospital of Hubei Province, Wuhan, China.
¹⁷ Department of Neurology, Shanghai Oriental Hospital, Shanghai, China.
¹⁸ Institute of Diagnostic and Interventional Neuroradiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
¹⁹ Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China bravezhang@126.com.

Abstract

Objectives: This work aimed to analyse the risk factors for poor outcomes and mortality among patients with anterior large vessel occlusion (LVO) ischaemic stroke, despite successful recanalisation.

Setting and participants: This study conducted a secondary analysis among patients who underwent successful recanalisation in the CAPTURE trial. The trial took place between March 2018 and September 2020 at 21 sites in China. The CAPTURE trial enrolled patients who had an acute ischaemic stroke aged 18-80 years with LVO in anterior circulation.

Interventions: Thrombectomy was immediately performed using Neurohawk or the Solitaire FR after randomisation in CAPTURE trial. Rescue treatment was available for patients with severe residual stenosis caused by atherosclerosis.

Primary and secondary outcome measures: The primary goal was to predict poor 90-day survival or mortality within 90 days post-thrombectomy. Univariate analysis, using the χ² test or Fisher's exact test, was conducted for each selected factor. Subsequently, a multivariable analysis was performed on significant factors (p≤0.10) identified through univariate analysis using the backward selection logistic regression approach.

Results: Among the 207 recruited patients, 79 (38.2%) exhibited poor clinical outcomes, and 26 (12.6%) died within 90 days post-thrombectomy. Multivariate analysis revealed that the following factors were significantly associated with poor 90-day survival: age ≥67 years, internal carotid artery (ICA) occlusion (compared with middle cerebral artery (MCA) occlusion), initial National Institutes of Health Stroke Scale (NIHSS) score ≥17 and final modified Thrombolysis in Cerebral Infarction (mTICI) score 2b (compared with mTICI 3). Additionally, the following factors were significantly associated with mortality 90 days post-thrombectomy: initial NIHSS score ≥17, ICA occlusion (compared with MCA occlusion) and recanalisation with more than one pass.

Conclusions: Age, NIHSS score, occlusion site, mTICI score and the number of passes can be independently used to predict poor 90-day survival or mortality within 90 days post-thrombectomy.

Trial registration number: NCT04995757.

Keywords: STROKE MEDICINE; Stroke; Stroke medicine.

Publication types

Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Arterial Occlusive Diseases* / etiology
Brain Ischemia* / etiology
Brain Ischemia* / surgery
Endovascular Procedures*
Humans
Infant
Infarction, Middle Cerebral Artery / therapy
Ischemic Stroke* / etiology
Retrospective Studies
Stroke* / etiology
Stroke* / surgery
Thrombectomy / adverse effects
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT04995757