Susceptibility vessel sign, a predictor of long-term outcome in patients with stroke treated with mechanical thrombectomy.

Beyeler, Morin; Rea, Erich; Weber, Loris; Belachew, Nebiyat Filate; Barvulsky Aleman, Enrique; Kielkopf, Moritz; Kurmann, Christoph C; Grunder, Lorenz; Piechowiak, Eike Immo I; Meinel, Thomas R; Heldner, Mirjam R; Seiffge, David; Pilgram-Pastor, Sara; Dobrocky, Tomas; Pabst, Thomas; Berger, Martin D; Jung, Simon; Arnold, Marcel; Gralla, Jan; Fischer, Urs; ... (2023). Susceptibility vessel sign, a predictor of long-term outcome in patients with stroke treated with mechanical thrombectomy. (In Press). Journal of neurointerventional surgery BMJ Publishing Group 10.1136/jnis-2023-020793

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BACKGROUND

The absence of the susceptibility vessel sign (SVS) in patients treated with mechanical thrombectomy (MT) is associated with poor radiological and clinical outcomes after 3 months. Underlying conditions, such as cancer, are assumed to influence SVS status and could potentially impact the long-term outcome. We aimed to assess SVS status as an independent predictor of long-term outcomes in MT-treated patients.

METHODS

SVS status was retrospectively determined in consecutive MT-treated patients at a comprehensive stroke center between 2010 and 2018. Predictors of long-term mortality and poor functional outcome (modified Rankin Scale (mRS) ≥3) up to 8 years were identified using multivariable Cox and logistic regression, respectively.

RESULTS

Of the 558 patients included, SVS was absent in 13% (n=71) and present in 87% (n=487) on baseline imaging. Patients without SVS were more likely to have active cancer (P=0.003) and diabetes mellitus (P<0.001) at the time of stroke. The median long-term follow-up time was 1058 days (IQR 533-1671 days). After adjustment for active cancer and diabetes mellitus, among others, the absence of SVS was associated with long-term mortality (adjusted HR (aHR) 2.11, 95% CI 1.35 to 3.29) and poor functional outcome in the long term (adjusted OR (aOR) 2.90, 95% CI 1.29 to 6.55).

CONCLUSION

MT-treated patients without SVS have higher long-term mortality rates and poorer long-term functional outcome. It appears that this association cannot be explained by comorbidities alone, and further studies are warranted.

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