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A novel predictor in endovascular treatment patients for cerebral perfusion and prognosis: CHA2DS2-VASC

  • Author Footnotes
    1 ORCID: 0000-0003-2243-6190.
    Mehmet Özbek
    Correspondence
    Corresponding author.
    Footnotes
    1 ORCID: 0000-0003-2243-6190.
    Affiliations
    Department of Cardiology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
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  • Author Footnotes
    2 ORCID: 0000-0001-6641-8205.
    Baran Arık
    Footnotes
    2 ORCID: 0000-0001-6641-8205.
    Affiliations
    Department of Cardiology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
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  • Author Footnotes
    3 ORCID: 0000-0002-9049-7123.
    Muhammed Demir
    Footnotes
    3 ORCID: 0000-0002-9049-7123.
    Affiliations
    Department of Cardiology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
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  • Author Footnotes
    4 ORCID: 0000-0003-4326-6418.
    Mehmet Zihni Bilik
    Footnotes
    4 ORCID: 0000-0003-4326-6418.
    Affiliations
    Department of Cardiology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
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  • Author Footnotes
    5 ORCID: 0000-0002-3544-2138.
    Mehmet Ata Akıl
    Footnotes
    5 ORCID: 0000-0002-3544-2138.
    Affiliations
    Department of Cardiology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
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  • Author Footnotes
    6 ORCID: 0000-0001-5510-3224.
    Fidel Demir
    Footnotes
    6 ORCID: 0000-0001-5510-3224.
    Affiliations
    Department of Neurology, Silopi State Hospital, Şırnak, Turkey
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  • Author Footnotes
    7 ORCID: 0000-0001-9394-4999.
    Hamza Gültekin
    Footnotes
    7 ORCID: 0000-0001-9394-4999.
    Affiliations
    Department of Neurology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
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  • Author Footnotes
    8 ORCID: 0000-0001-9669-6804.
    Eşref Akıl
    Footnotes
    8 ORCID: 0000-0001-9669-6804.
    Affiliations
    Department of Neurology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
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  • Author Footnotes
    1 ORCID: 0000-0003-2243-6190.
    2 ORCID: 0000-0001-6641-8205.
    3 ORCID: 0000-0002-9049-7123.
    4 ORCID: 0000-0003-4326-6418.
    5 ORCID: 0000-0002-3544-2138.
    6 ORCID: 0000-0001-5510-3224.
    7 ORCID: 0000-0001-9394-4999.
    8 ORCID: 0000-0001-9669-6804.

      Highlights

      • There is a correlation between the CHA2DS2-VASc score and the TICI score, which is the cerebral perfusion score.
      • There is a significant relationship between poor TICI score and poor stroke prognosis and complications.
      • CHA2DS2-VASc score may become a stronger indicator score with the addition of a GFR-related and any inflammatory score.
      • Adding additional medical and interventional treatments to the procedure in a way to make the TICI perfusion score ≥ 2c in patients with TICI score < 2c may provide good prognostic results.

      Abstract

      Objective

      Thrombolysis in Cerebral Infarction(TICI) score is used to objectively evaluate cerebral perfusion after intervention in acute stroke with mechanical thrombectomy. In our study, we aimed to compare the results of patients with successful TICI perfusion score (TICI ≥ 2c) with the results of patients with poor TICI perfusion score (TICI < 2c) and to investigate the relationship of the CHA2DS2-VASc scoring system with the final TICI perfusion score and other endpoints.

      Methods

      For this retrospective, single-center, cross-sectional study, 278 patients who underwent endovascular thrombectomy were screened consecutively by the interventional neurology department of hospital. The primary endpoint of the study was in-hospital and 1-year all-cause death. All patients underwent cranial imaging to evaluate hemorrhagic transformation after the procedure.

      Results

      It was observed that CHA2DS2-VASc score was significantly higher in the poor cerebral perfusion group than in the succesful cerebral perfusion group (3.19 ± 1.8 vs 2.72 ± 1.73, p = 0.046). According to Kaplan Meier's analysis, a significant difference was observed in the group with a CHA2DS2-VASc score > 2.5 in terms of all-cause mortality at follow-up compared to the group with a low CHA2DS2-VASc score (p = 0.002). According to Kaplan Meier's analysis, a significant difference was observed in the group with a poor TICI score compared to the group with a succesful one in terms of all-cause mortality at follow-up (p < 0.001). Cox regression model showed that poor TICI score group, Age ≥ 75 years, lower glomerular filtariton rate (GFR), higher high-sensitive C-reactive protein (Hs-CRP), and higher admission NIHSS score were independent predictors of 1-year all-cause mortality.

      Conclusion

      High CHA2DS2-VASc score has been shown to be a predictor of unsuccessful cerebral perfusion score and 1-year mortality after mechanical thrombectomy in stroke patients. As a result of our research, it has been shown that complete or nearly complete reperfusion has more positive results than partial reperfusion.

      Keywords

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