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Background <p>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&#xa0;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.</p> Methods <p>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&#xa0;month follow-up. Univariate group comparisons and multiple logistic regression analysis were performed to identify patients with high odds for survival or lethal outcome.</p> Results <p>We report 11.6% (757/6,518) 3&#xa0;month mortality following hospital discharge after LVO treated by MT. Besides better functional outcome at discharge (modified Rankin scale &lt; 4, odds ratio, OR [95% confidence interval, CI]: 2.38 [1.71–3.32], <i>p</i> &lt; 0.001; National Institute of Health Stroke scale &lt; 8, OR [95%CI]: 3.45 [2.55–4.66], <i>p</i> &lt; 0.001), intravenous thrombolysis (OR [95%CI]: 1.48 [1.17–1.88], <i>p</i> = 0.001), successful recanalization (OR [95%CI]: 1.43 [1.08–1.90], <i>p</i> = 0.014) and discharge to a neurorehabilitative facility (versus nursing home: OR [95%CI]: 0.39 [0.26–0.58], <i>p</i> &lt; 0.001; versus home: OR [95%CI]: 0.69 [0.49–0.97], <i>p</i> = 0.032) were independent predictors of survival. Predictors of lethal outcome were older age (OR [95%CI]: 1.09 [1.07–1.10], <i>p</i> &lt; 0.001), male sex (OR [95%CI]: 1.24 [1.00–1.55], <i>p</i> = 0.049), premorbid disability (OR [95%CI]: 1.47 [1.08–2.02], <i>p</i> = 0.016), active smoking (OR [95%CI]: 1.51 [1.06–2.14], <i>p</i> = 0.023), anticoagulation therapy prior to LVO (OR [95%CI]: 1.45 [1.09–1.92], <i>p</i> = 0.010), stroke etiology, general anaesthesia during MT (OR [95%CI]: 1.31 [1.02–1.69], <i>p</i> = 0.035) and intracerebral haemorrhage (OR [95%CI]: 1.50 [1.13–1.99], <i>p</i> = 0.005).</p> Conclusions <p>Lethal outcome after hospital discharge within 3&#xa0;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.</p> Trial registration <p>ClinicalTrials.gov (Identifier: NCT03356392, Date of registration: 2017/11/22).</p>

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

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  • 发表日期：

    2025年10月1日

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  • Marianne Hahn,
  • Sonja Gröschel,
  • Livia Sophie Lang,
  • Ahmed E. Othman,
  • Klaus Gröschel,
  • Timo Uphaus,
  • Arno Reich,
  • Omid Nikoubashman,
  • Christian Nolte,
  • Eberhard Siebert,
  • Gabor C. Petzold,
  • Franziska Dorn,
  • Jan Hendrik Schäfer,
  • Fee Keil,
  • Ilko L. Maier,
  • Marielle S. Ernst,
  • Gerhard F. Hamann,
  • Michael Braun,
  • Anna Alegiani,
  • Joachim Röther,
  • Bernd Eckert,
  • Maximilian Schell,
  • Götz Thomalla,
  • Fabian Flottmann,
  • Jens Fiehler,
  • Mario Abruscato,
  • Sven Thonke,
  • Arman Gregor,
  • Evdokia Evangelidou,
  • Peter Schellinger,
  • Jan Borggrefe,
  • Lars Kellert,
  • Hanna Zimmermann,
  • Steffen Tiedt,
  • Silke Wunderlich,
  • Tobias Boeckh-Behrens,
  • Martina Petersen,
  • Lars Krause,
  • Sven Poli,
  • Ulrike Ernemann

摘要

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).