Prevalence and Impact of Medical Complications on Clinical Outcomes in Acute Ischemic Stroke Patients after Endovascular Therapy - Data from a Comprehensive Stroke Unit in China.

OBJECTIVE: We aim to assess the incidence and impact of in-hospital medical complications (MCs) on clinical outcomes in acute ischemic stroke (AIS) patients after endovascular therapy (EVT).

METHODS: AIS patients who underwent EVT were consecutively recruited from January 2019 to July 2022. The primary outcome was a poor 3-month functional outcome, defined as a modified Rankin Scale score (mRS) of 3-6. The safety variables were symptomatic intracerebral hemorrhage (sICH) and mortality at seven and 30 days.

RESULTS: A total of 306 (50.1%) patients experienced at least one of the MCs. The most common MC was pneumonia (42.6%). Multivariate analysis revealed that the setting of MCs was an independent predictor of a poor 3-month functional outcome (adjusted odds ratio [aOR] 4.40, 95% confidence interval [CI] 3.01-6.42; P<0.001). In the subgroup analysis, this trend was significant, especially in the patients aged 60 to75 years (aOR 5.87, 95% CI 3.45-9.97; P<0.001) or with baseline NIHSS (≤16) (aOR 5.05, 95% CI 2.84-9.01; P<0.001). For individuals, cardiac events (aOR 8.56, 95% CI 4.05-18.09; P<0.001), pneumonia (aOR 5.08, 95%CI 3.42-7.55; P<0.001), and gastrointestinal bleeding (GIB) (aOR 6.12, 95%CI 3.40-11.01; P<0.001) were independently associated with the poor 3-month outcome. The setting of MCs was independently associated with sICH (aOR 2.11, 95% CI 1.22-3.64; P=0.007) and mortality at 30 days (aOR 2.11, 95% CI 1.22-3.64; P=0.007) after adjustment, but not with mortality at seven days.

CONCLUSIONS: MCs in AIS patients after EVT have a high incidence, despite successful reperfusion, adversely affecting clinical outcomes and increasing short-term mortality.