Description: Background and Purpose— Computed tomography angiography is an accurate noninvasive method to diagnose intracranial steno-occlusive disease (ICAD) at initial presentation for stroke. We aimed to identify features of computed tomography angiography associated with unfavorable outcome. Methods— We identified patients with ICAD in the Screening Technology and Outcomes Project in Stroke Study, a prospective imaging-based study of stroke outcomes, in consecutive patients with ischemic stroke or transient ischemic attack (TIA) presenting to 2 academic medical centers. All patients underwent computed tomography angiography, which were graded by 2 neuroradiologists independently. Univariate and multiple logistic regression was used to evaluate predictors of favorable outcome at 6 months, defined as a modified Rankin Scale ≤2. Results— Among 539 patients that met study entry criteria, ICAD was identified in 212 patients (39%); 116 patients (22%) had concurrent extraintracranial lesions, and 66 patients (12%) had multiple sites of ICAD. Patients with ICAD had more severe stroke (median National Institutes of Health Stroke Scale, 9 versus 3; P 〈0.001), worse outcomes at 6 months (modified Rankin Scale, 0–2; 57% versus 73%; P 〈0.001), and higher mortality (18% versus 8%; P =0.001). In the multivariate model, age (odds ratio [OR], 0.75 per decade; 95% confidence interval [CI], 0.65–0.87), female sex (OR, 0.49; 95% CI, 0.32–0.73), multiple sites of ICAD (OR, 0.53; 95% CI, 0.29–0.97), complete occlusion (OR, 0.42; 95% CI, 0.25–0.72), and concurrent extraintracranial lesions (OR, 0.51; 95% CI, 0.31–0.84) negatively predicted favorable outcome. Conclusions— Findings of multiple sites of ICAD from computed tomography angiography, concurrent extraintracranial lesions, and complete occlusion are independent predictors of unfavorable outcome at 6 months.

Description: Background and Purpose— High revascularization rates in large-vessel occlusion strokes treated by mechanical thrombectomy are not always associated with good clinical outcomes. We evaluated predictors of functional dependence despite successful revascularization among patients with acute ischemic stroke treated with thrombectomy. Methods— We analyzed the pooled data from the Multi Mechanical Embolus Removal in Cerebral Ischemia (MERCI), Thrombectomy Revascularization of Large Vessel Occlusions in Acute Ischemic Stroke (TREVO), and TREVO 2 trials. Successful revascularization was defined as thrombolysis in cerebral infarction score 2b or 3. Functional dependence was defined as a score of 3 to 6 on the modified Rankin Scale at 3 months. We assessed relationship of demographic, clinical, angiographic characteristics, and hemorrhage with functional dependence despite successful revascularization. Results— Two hundred and twenty-eight patients with successful revascularization had clinical outcome follow-up. The rates of functional dependence with endovascular success were 48.6% for Trevo thrombectomy and 58.0% for Merci thrombectomy. Age (odds ratio, 1.04; 95% confidence interval, 1.02–1.06 per 1-year increase), National Institutes of Health Stroke Scale score (odds ratio, 1.08; 95% confidence interval, 1.02–1.15 per 1-point increase), and symptom onset to endovascular treatment time (odds ratio, 1.11; 95% confidence interval, 1.01–1.22 per 30-minute delay) were predictors of functional dependence despite successful revascularization. Symptom onset to reperfusion time beyond 5 hours was associated with functional dependence. All subjects with symptomatic intracranial hemorrhage had functional dependence. Conclusions— One half of patients with successful mechanical thrombectomy do not have good outcomes. Age, severe neurological deficits, and delayed endovascular treatment were associated with functional dependence despite successful revascularization. Our data support efforts to minimize delays to endovascular therapy in patients with acute ischemic stroke to improve outcomes. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00318071, NCT01088672, and NCT01270867.