Introduction: Despite mechanical thrombectomy has achieved a dramatic improvement on ischemic stroke prognosis, up to 50% of patients treated with this approach do not have good functional outcome. Besides age and baseline infarct core, comorbidity might play a role in stroke prognosis. We aim to study the capacity of Charlson comorbidity index (CCI) in predicting mortality and functional outcome in acute ischemic stroke patients who underwent mechanical thrombectomy.
Methods: We studied 228 consecutive patients (59% male, mean age 65y) with acute anterior circulation arterial occlusion treated with stent retrievers between May 2009 and March 2015. Demographical data, stroke severity, ASPECTS score at baseline and medical conditions included in the CCI were collected and CCI score was calculated retrospectively. We considered low comorbidity if CCI score was <2 and high comorbidity if CCI score was ≥2. Complete arterial revascularization was defined as a TICI ≥2b on final angiographic run. Good functional outcome was defined as a modified Rankin score ≤2 at 90 days.
Results: The CCI was 0 in 47% of patients, 1 in 23%, 2 in 15%, 3 in 10% and ≥4 in 5%. CCI of 2 or more was associated with poor functional outcome (70.6% vs 50%, p = 0.004) and mortality (33.8% vs. 11.7%, p <0.001) compared to patients with low CCI. In a logistic regression adjusted by stroke severity, age, ASPECTS score at baseline and arterial revascularization, high comorbidity remained as an independent predictor of poor outcome (OR 2.9; 95% CI 1.4-5.8) and mortality (OR 4.6, 95% CI 2.0-10.3).
Conclusions: High comorbidity assessed by Charlson Comorbidity Index is associated with poor functional outcome and mortality in acute stroke patients treated with mechanical thrombectomy.