TITLE:
Admission Motor Strength Grade Predicts Mortality in Patients with Acute Ischemic Stroke Undergoing Mechanical Thrombectomy
AUTHORS:
Vishnumurthy Shushrutha Hedna, Aakash N. Bodhit, Saeed Ansari, Adam D Falchook, Latha G. Stead, Sharathchandra Bidari, Brian L Hoh, Kenneth M Heilman, Michael F Waters
KEYWORDS:
Motor Grade; Collaterals; Ischemic Stroke; Endovascular Intervention; Outcome after Stroke; Mortality after Stroke; Acute Stroke; Endovascular Treatment; Mechanical Thrombectomy
JOURNAL NAME:
Neuroscience and Medicine,
Vol.4 No.1,
March
5,
2013
ABSTRACT: Background: The
mortality due to mechanical thrombectomy (MT) in the acute treatment of
intracranial arterial occlu- sions can be up to 45%. The SWIFT (Solitaire FR with the Intention for
Thrombectomy) and Multi MERCI (mechani- cal embolus removal in cerebral ischemia) trials have evaluated the
safety and efficacy of MT. It may be important to determine pre-procedural
factors that help predict post-intervention prognosis. We sought to determine
if admission medical research council (MRC) motor strength grade along with
other factors can be used as predictor of mortality after MT for acute ischemic
stroke. Methods: Retrospective
analysis of stroke database assessing outcomes in all 62 patients who underwent
MT as an intervention for acute ischemic stroke, with or without concurrent
intravenous thrombolysis was done. Five baseline variables were included in
univariate and multivariate analyses to define the in- dependent predictors of mortality
during current hospitalization. The medical research council (MRC) motor grade
(0 - 5); modified collateral flow (CS)
grading (0 - 3); age; acute and chronic
co-morbidities were used as the baseline vari- ables. If motor strength grade were
different in upper and lower extremities, then the lower grade was used. Age
was analyzed independently as well as dichotomized using 80 as cut-off value.
Relevant stroke related acute and chronic co-morbidities were given 1 point
each and mean calculated. Results: In the univariate analysis, low (0 - 1) motor strength
grade (OR, 0.11; 95% CI, 0.021 - 0.33; p = 0.001) and age (OR, 1.06; 95% CI, 1.02 - 1.12; p = 0.011) was sig- nificantly associated with mortality.
The presence of collateral flow, acute and chronic co-morbidities were not signifi- cantly associated with mortality. In
the multivariate analysis, motor grade retained its statistical significance
for morta- lity (OR, 0.09;
95% CI, 0.01 - 0.32; p = 0.003) along with chronic co-morbidity
(OR, 1.52; 95% CI 1.05 - 2.43; p