Mortality within three months after nonfatal ischemic stroke treated by mechanical thrombectomy in routine care—data from the German Stroke Registry

Neurological Research and Practice, vol. 7, pp. 71

Abstract

BACKGROUND: Mechanical thrombectomy (MT) is a highly effective treatment for large vessel occlusion (LVO) ischemic stroke. However, a substantial share of patients have lethal outcome within 3 months. Individualization of outcome prognostication is needed to support clinical decision-making throughout the care pathway after MT. We investigate predictors of lethal outcome in patients with nonfatal LVO, defined by discharge alive from primary treating hospital, in a large prospective registry study of MT under routine care conditions. METHODS: 6,518 patients with nonfatal LVO treated by MT enrolled in the German Stroke Registry-Endovascular Treatment from May 2015-December 2021 were analysed with regard to lethal outcome by 3 month follow-up. Univariate group comparisons and multiple logistic regression analysis were performed to identify patients with high odds for survival or lethal outcome. RESULTS: We report 11.6% (757/6,518) 3 month mortality following hospital discharge after LVO treated by MT. Besides better functional outcome at discharge (modified Rankin scale < 4, odds ratio, OR [95% confidence interval, CI]: 2.38 [1.71-3.32], p < 0.001; National Institute of Health Stroke scale < 8, OR [95%CI]: 3.45 [2.55-4.66], p < 0.001), intravenous thrombolysis (OR [95%CI]: 1.48 [1.17-1.88], p = 0.001), successful recanalization (OR [95%CI]: 1.43 [1.08-1.90], p = 0.014) and discharge to a neurorehabilitative facility (versus nursing home: OR [95%CI]: 0.39 [0.26-0.58], p < 0.001; versus home: OR [95%CI]: 0.69 [0.49-0.97], p = 0.032) were independent predictors of survival. Predictors of lethal outcome were older age (OR [95%CI]: 1.09 [1.07-1.10], p < 0.001), male sex (OR [95%CI]: 1.24 [1.00-1.55], p = 0.049), premorbid disability (OR [95%CI]: 1.47 [1.08-2.02], p = 0.016), active smoking (OR [95%CI]: 1.51 [1.06-2.14], p = 0.023), anticoagulation therapy prior to LVO (OR [95%CI]: 1.45 [1.09-1.92], p = 0.010), stroke etiology, general anaesthesia during MT (OR [95%CI]: 1.31 [1.02-1.69], p = 0.035) and intracerebral haemorrhage (OR [95%CI]: 1.50 [1.13-1.99], p = 0.005). CONCLUSIONS: Lethal outcome after hospital discharge within 3 months after MT is frequent, accounting for more than one quarter of overall 3-month mortality after MT of LVO. Predictors of survival enable individual outcome prognostication, which assists clinical decision-making with regard to surveillance concerning complications, rehabilitative resource allocation and counselling about goals of care. TRIAL REGISTRATION: ClinicalTrials.gov (Identifier: NCT03356392, Date of registration: 2017/11/22).

Authors 37

1. Marianne Hahn

   University Medical Center of the Johannes Gutenberg University Mainz

   Affiliation as printed

   Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany

2. Sonja Gröschel

   University Medical Center of the Johannes Gutenberg University Mainz

   Affiliation as printed

   Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany

3. Mohamed I. A. Othman

   University Medical Center of the Johannes Gutenberg University Mainz

   Affiliation as printed

   Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany

4. Klaus Gröschel corresponding

   Johannes Gutenberg University Mainz · University Medical Center of the Johannes Gutenberg University Mainz

   Affiliation as printed

   Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany. klaus.groeschel@unimedizin-mainz.de

5. Timo Uphaus

   University Medical Center of the Johannes Gutenberg University Mainz

   Affiliation as printed

   Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany

6. Arno Reich Aachen Department of Neurology

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany

7. Omid Nikoubashman Aachen Department of Neuroradiology

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Neuroradiology, University Hospital, RWTH Aachen University, Aachen, Germany

8. Christian Hans Nolte

   Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany

9. Eberhard Siebert

   Stiftung Charité · Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Department of Neuroradiology, Charité – Universitätsmedizin Berlin, Berlin, Germany

10. Gabor C. Petzold

    University of Bonn · University Hospital Bonn

    Affiliation as printed

    Department of Vascular Neurology, University Hospital Bonn, Bonn, Germany

11. Franziska Dorn

    University Hospital Bonn

    Affiliation as printed

    Department of Neuroradiology, University Hospital Bonn, Bonn, Germany

12. Jan Hendrik Schäfer

    University Hospital Frankfurt

    Affiliation as printed

    Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany

13. Fee Christiane Keil

    University Hospital Frankfurt

    Affiliation as printed

    Department of Neuroradiology, University Hospital Frankfurt, Frankfurt am Main, Germany

14. Ilko Maier

    Universitätsmedizin Göttingen

    Affiliation as printed

    Department of Neurology, University Medical Center Göttingen, Göttingen, Germany

15. Marielle Sophie Ernst

    Universitätsmedizin Göttingen

    Affiliation as printed

    Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany

16. Gerhard F. Hamann
    Affiliation as printed

    Department of Neurology, Bezirkskrankenhaus Günzburg, Günzburg, Germany

17. Michael S Braun
    Affiliation as printed

    Department of Neuroradiology, Bezirkskrankenhaus Günzburg, Günzburg, Germany

18. Anna Christina Alegiani

    Asklepios Klinik Altona · Asklepios

    Affiliation as printed

    Department of Neurology, Asklepios Klinik Hamburg Altona, Hamburg, Germany

19. Joachim A. Rother

    Asklepios Klinik Altona · Asklepios

    Affiliation as printed

    Department of Neurology, Asklepios Klinik Hamburg Altona, Hamburg, Germany

20. Bernd Eckert

    Asklepios Klinik Altona · Asklepios

    Affiliation as printed

    Department of Neuroradiology, Asklepios Klinik Hamburg Altona, Hamburg, Germany

21. Maximilian Schell

    University Medical Center Hamburg-Eppendorf

    Affiliation as printed

    Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

22. Götz Thomalla

    University Medical Center Hamburg-Eppendorf

    Affiliation as printed

    Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

23. Fabian Flottmann

    University Medical Center Hamburg-Eppendorf

    Affiliation as printed

    Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

24. Jens Fiehler

    University Medical Center Hamburg-Eppendorf

    Affiliation as printed

    Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

25. Mario Abruscato

    Klinikum Hanau

    Affiliation as printed

    Department of Neurology, Klinikum Hanau, Hanau, Germany

26. Sven Thonke

    Klinikum Hanau

    Affiliation as printed

    Department of Neurology, Klinikum Hanau, Hanau, Germany

27. Peter Dieter Schellinger

    Johannes Wesling Klinikum Minden

    Affiliation as printed

    Department of Neurology, Mühlenkreiskliniken, Johannes Wesling Klinikum Minden, Minden, Germany

28. Jan Borggrefe

    Johannes Wesling Klinikum Minden

    Affiliation as printed

    Department of Radiology, Mühlenkreiskliniken, Johannes Wesling Klinikum Minden, Minden, Germany

29. Lars Kellert

    Ludwig-Maximilians-Universität München

    Affiliation as printed

    Department of Neurology, Ludwig Maximilian University (LMU), Munich, Munich, Germany

30. Hanna Zimmermann

    Ludwig-Maximilians-Universität München

    Affiliation as printed

    Department of Neuroradiology, Ludwig Maximilian University (LMU), Munich, Munich, Germany

31. Steffen Tiedt

    Institut für Schlaganfall- und Demenzforschung · Ludwig-Maximilians-Universität München

    Affiliation as printed

    Institute for Stroke and Dementia Research, Ludwig Maximilian University (LMU), Munich, Munich, Germany

32. Silke Wunderlich

    TUM Klinikum · Technical University of Munich

    Affiliation as printed

    Department of Neurology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany

33. Tobias Boeckh‐Behrens

    TUM Klinikum · Technical University of Munich

    Affiliation as printed

    Department of Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany

34. Martina Petersen

    Klinikum Osnabrück

    Affiliation as printed

    Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany

35. Lars Udo Krause

    Klinikum Osnabrück

    Affiliation as printed

    Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany

36. Sven Poli

    Hertie Institute for Clinical Brain Research · University of Tübingen

    Affiliation as printed

    Department of Neurology & Stroke, University Hospital Tübingen; Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany

37. Ulrike Ernemann

    Universitätsklinikum Tübingen

    Affiliation as printed

    Department of Neuroradiology, University Hospital Tübingen, Tübingen, Germany