• Stephanie H Chen, David McCarthy, Vasu Saini, Marie-Christine Brunet, Eric C Peterson, Dileep Yavagal, and Robert M Starke.
• Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA. Electronic address: stephanie.chen@jhsmiami.org.
• World Neurosurg. 2020 Nov 1; 143: e503-e515.

BackgroundObesity is an established risk factor for the development of acute ischemic stroke. However, its effect on clinical outcomes after acute ischemic stroke has remained controversial. In the present study, we evaluated the association of body mass index (BMI) on outcomes after mechanical thrombectomy (MT) for large vessel occlusion acute ischemic stroke (LVOS).MethodsWe reviewed our prospective endovascular database for patients who had undergone MT for LVOS from 2015 to 2018. The BMI was analyzed as a continuous and categorical variable, with the latter defined as BMI, <18.5 kg/m2 (underweight); BMI, 18.5-24.9 kg/m2 (normal); BMI, 25-29.9 kg/m2 (overweight), and BMI, >30 kg/m2 (obese). Multivariate analysis was used to determine the outcome predictors.ResultsA total of 335 patients had undergone MT, with 7 (2.1%) classified as underweight, 107 (31.9%) normal, 141 (42.1%) overweight, and 80 (23.9%) obese. The procedural times, techniques, and reperfusion success (treatment in cerebral infarction score >2b) were not significantly different among the BMI categories. A significant inverse linear correlation was found between the BMI and symptomatic hemorrhagic. For patients with successful reperfusion (treatment in cerebral infarction score >2b), we also found a significant bell-shaped relationship between the BMI and functional independence (modified Rankin scale score <3), with high and low BMIs associated with worse outcomes. For patients without post-MT symptomatic hemorrhage, a significant linear correlation was found between BMI and inpatient mortality.ConclusionFor LVOS patients treated with MT, a high BMI will not affect procedural success. However, it was independently associated with lower rates of functional independence in recanalized patients. Thus, the obesity paradox does not appear to pertain to MT, although larger prospective studies are necessary.Copyright © 2020 Elsevier Inc. All rights reserved.

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