Benefit from successful recanalization in an Italian cohort of stroke patients receiving endovascular treatments according to the DIRECT-MT trial criteria

Introduction To identify predictors of 3-month mRS score and to estimate the benefit from successful recanalization across baseline subgroups of Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS) cohort of stroke patients receiving endovascular treatments according to the DIRECT-MT criteria. Methods Using a model of propensity score matching, we retrospectively identified an IRETAS cohort of 137 patients receiving bridging who were matched with 137 patients receiving MT alone according to the DIRECT-MT criteria. Results Differences were found between DIRECT-MT and IRETAS cohorts for 3-month mRS score 0 to 1 (23.5% vs. 33.1%) and 0 to 2 (36.7% vs. 47.1%), successful (82% vs. 76.7%) and complete recanalization (32.3% vs. 58.8%). Among unfavorable predictors for 3-month mRS shift, diabetes mellitus (18.9% vs. 13.9%) and asymptomatic intracerebral hemorhage (ICH) (34.8% vs. 25.5%) were more frequent in the DIRECT-MT, whereas age >= 80 years (23.7% vs. 15.3%) and pre-stroke mRS score >0 (16.1% vs. 7.8%) were more frequent in the IRETAS. The direction of effect on the 3-month mRS shift (6 to 0) favored successful recanalization across all strata. Greatest benefit from successful recanalization was observed in patients with most severe strokes (NIHSS >= 20, OR:4.002; 16-19, OR:3.292; 2-5, OR:2.470) and most proximal occlusion site (intra-cranial ICA, OR:4.092; M1-MCA, OR:3.705; M2-MCA, OR:2.001), in younger patients (18-59 years, OR:3.677; 60-79, OR:3.267; >= 80, OR:1.993), and in patients who started the treatment earlier (onset-to-groin time <= 205 min, OR:4.361; onset-to-groin time >205, OR:2.326). Conclusions The benefit from successful recanalization for 3-month mRS shift in the direction of favorable outcome was different across baseline subgroups.

Automated summary

This study aims to identify predictors of 3-month mRS score and evaluate the benefit from successful recanalization in stroke patients receiving endovascular treatments. The results show that the benefit from successful recanalization varies across baseline subgroups, with the greatest impact observed in patients with severe strokes, in those with proximal occlusion sites, in younger patients, and in those who start treatment earlier.