TY - JOUR
T1 - Timing and causes of death after endovascular thrombectomy in patients with acute ischemic stroke
AU - Sluis, Wouter M.
AU - Hinsenveld, Wouter H.
AU - Goldhoorn, Robert Jan B.
AU - Potters, Lianne H.
AU - Bruggeman, Agnetha A.E.
AU - van der Hoorn, Anouk
AU - Bot, Joseph C.J.
AU - van Oostenbrugge, Robert J.
AU - Lingsma, Hester F.
AU - Hofmeijer, Jeannette
AU - van Zwam, Wim H.
AU - BLM Majoie, Charles
AU - Bart van der Worp, H.
N1 - Publisher Copyright:
© European Stroke Organisation 2022.
PY - 2023/3
Y1 - 2023/3
N2 - Introduction: Endovascular thrombectomy (EVT) increases the chance of good functional outcome after ischemic stroke caused by a large vessel occlusion, but the risk of death in the first 90 days is still considerable. We assessed the causes, timing and risk factors of death after EVT to aid future studies aiming to reduce mortality. Patients and methods: We used data from the MR CLEAN Registry, a prospective, multicenter, observational cohort study of patients treated with EVT in the Netherlands between March 2014, and November 2017. We assessed causes and timing of death and risk factors for death in the first 90 days after treatment. Causes and timing of death were determined by reviewing serious adverse event forms, discharge letters, or other written clinical information. Risk factors for death were determined with multivariable logistic regression. Results: Of 3180 patients treated with EVT, 863 (27.1%) died in the first 90 days. The most common causes of death were pneumonia (215 patients, 26.2%), intracranial hemorrhage (142 patients, 17.3%), withdrawal of life-sustaining treatment because of the initial stroke (110 patients, 13.4%) and space-occupying edema (101 patients, 12.3%). In total, 448 patients (52% of all deaths) died in the first week, with intracranial hemorrhage as most frequent cause. The strongest risk factors for death were hyperglycemia and functional dependency before the stroke and severe neurological deficit at 24–48 h after treatment. Discussion and conclusion: When EVT fails to decrease the initial neurological deficit, strategies to prevent complications like pneumonia and intracranial hemorrhage after EVT could improve survival, as these are often the cause of death.
AB - Introduction: Endovascular thrombectomy (EVT) increases the chance of good functional outcome after ischemic stroke caused by a large vessel occlusion, but the risk of death in the first 90 days is still considerable. We assessed the causes, timing and risk factors of death after EVT to aid future studies aiming to reduce mortality. Patients and methods: We used data from the MR CLEAN Registry, a prospective, multicenter, observational cohort study of patients treated with EVT in the Netherlands between March 2014, and November 2017. We assessed causes and timing of death and risk factors for death in the first 90 days after treatment. Causes and timing of death were determined by reviewing serious adverse event forms, discharge letters, or other written clinical information. Risk factors for death were determined with multivariable logistic regression. Results: Of 3180 patients treated with EVT, 863 (27.1%) died in the first 90 days. The most common causes of death were pneumonia (215 patients, 26.2%), intracranial hemorrhage (142 patients, 17.3%), withdrawal of life-sustaining treatment because of the initial stroke (110 patients, 13.4%) and space-occupying edema (101 patients, 12.3%). In total, 448 patients (52% of all deaths) died in the first week, with intracranial hemorrhage as most frequent cause. The strongest risk factors for death were hyperglycemia and functional dependency before the stroke and severe neurological deficit at 24–48 h after treatment. Discussion and conclusion: When EVT fails to decrease the initial neurological deficit, strategies to prevent complications like pneumonia and intracranial hemorrhage after EVT could improve survival, as these are often the cause of death.
KW - death
KW - endovascular treatment
KW - intracerebral hemorrhage
KW - ischemic stroke
KW - malignant infarction
KW - mortality
KW - pneumonia
KW - space-occupying edema
KW - Stroke
KW - thrombectomy
UR - http://www.scopus.com/inward/record.url?scp=85144180863&partnerID=8YFLogxK
U2 - 10.1177/23969873221143210
DO - 10.1177/23969873221143210
M3 - Article
C2 - 37021180
AN - SCOPUS:85144180863
SN - 2396-9873
VL - 8
SP - 215
EP - 223
JO - European Stroke Journal
JF - European Stroke Journal
IS - 1
ER -