To investigate the temporality and causes of mortality among patients receiving reperfusion therapy for LVO strokes.

Mortality after acute reperfusion treatment of LVO strokes is not insignificant. Identifying causes and temporality of mortality may improve outcomes.

We retrospectively reviewed patients treated for LVO stroke at our comprehensive stroke center between December 2011 and February 2020. LVO was defined as occlusion of intracranial anterior (ICA/MCA/ACA/PCA) or posterior (VA/BA) circulation. Cause of death (COD) as reported in patients’ death/discharge summaries was classified broadly as related or unrelated to stroke. Underlying COD was further described as non-hemorrhagic/non-infectious sequelae of stroke (NHNIS; e.g., respiratory failure, herniation), symptomatic intracerebral hemorrhage (sICH), infection, systemic disease, chronic illness, or unknown. Death was characterized as having occurred within 0-2 days, 3-7 days, 8-30 days, or 31-90 days of presentation.

Among the 3520 patients with LVO strokes who received IV-tPA and/or endovascular thrombectomy, 804 (23%) died within 3 months. This is a preliminary analysis of the first 218 of these patients. Most patients died between 3-7 days (31%) or 0-2 days (23%) of presentation. Overall, 91% of patients died from stroke-related illness. The most common underlying COD within the first 7 days were NHNIS (58%) and sICH (25%), within 8-30 days were NHNIS (33%) and infection (13%), and from 1-3 months was infection (23%). There was no significant difference in these data between patients receiving endovascular thrombectomy versus IV-tPA alone.

At our center, nearly a quarter of patients receiving IV-tPA and/or thrombectomy for LVO strokes died within 3 months of presentation, and half of these patients died within the first week of presentation. The most common underlying COD within the first month were NHNIS and sICH, while the most common COD from 1-3 months was infection. Future analyses of predictors of early and late mortality is warranted.