Patients with stroke or transient ischemic attack (TIA) are at high early risk of mortality and morbidity. Current risk prediction tools focus on patients after hospital discharge but not on those surviving to outpatient follow-up. We examined whether demographic and medical history data could predict 1-year stroke recurrence and mortality, among those discharged alive and event-free for 90 days after stroke and 1 day after TIA.

Data were obtained from the Ontario Stroke Registry (13,848 stroke and 13,059 TIA patients) and linked to administrative databases. Two-thirds of each cohort were used for model derivation and one-third for validation. Multivariable regression models were used to predict stroke recurrence and all-cause mortality.

There were 238 (2.71%) recurrent strokes in the ischemic stroke and 298 (3.44%) in the TIA cohorts at one year. Increasing age and previous stroke/TIA were associated with an increased risk of recurrent stroke in both cohorts. A higher modified Rankin Scale and diabetes were associated with an increased risk of recurrent stroke in the stroke cohort and heart failure, smoking and discharge location in the TIA cohort. Time-dependent areas under the curve were modest, 0.59 (0.54–0.64) and 0.59 (0.55–0.64) for the stroke and TIA validation cohorts, respectively. C-statistics from derivation and validation cohorts for mortality ranged from 0.74–0.78.

The predictive accuracy of the models was quite low after accounting for several risk factors. Additional risk factors associated with stroke recurrence for people seen in outpatient stroke clinics, and innovative approaches to individualized secondary prevention are needed.

Achieving a first pass recanalization (FPR) improves clinical outcomes in patients with basilar artery strokes, but its association with initial infarct burden is unknown. We aimed to study the benefits of FPR for basilar artery strokes by initial infarct burden using the Posterior Circulation Alberta Stroke Program Early CT score (pc-ASPECTS).

We retrospectively analyzed the prospective multicentric Endovascular Treatment of Ischemic Stroke registry and included 194 patients diagnosed with an acute basilar artery occlusion who were treated with thrombectomy. Our primary outcome was a modified Rankin Scale (mRS) of 0–3 at 90 days, and our secondary outcomes were an mRS of 4–6 and mortality. We compared the 90-day clinical outcomes of achieving an FPR versus multiple thrombectomy passes based on patients’ initial infarct size on pretreatment MRI: small (pc-ASPECTS = 9–10), medium (pc-ASPECTS = 6–8) and large (pc-ASPECTS <6).

Patients with a medium or large infarct size had significantly better outcomes (mRS 0–3 at 3 months) if FPR was achieved than if multiple passes were required (RR = 1.61, 95% CI: 1.16, 2.24; p-value = 0.005; and RR = 3.41, 95% CI: 1.54–7.57; p-value = 0.003, respectively). No similar difference was seen among patients with small infarcts. Achieving an FPR was also associated with a significantly lower mortality risk among patients with a moderate infarct size (RR = 0.36, 95% CI: 0.17–0.79; p-value = 0.010) but not with those with small or large infarcts.

Achieving an FPR significantly improves clinical outcomes in acute stroke patients with basilar artery occlusions undergoing thrombectomy when their infarcts are medium or large. Ongoing research to develop surgical techniques to achieve FPR is crucial to improving patients’ prognoses.