Mechanical Thrombectomy in Acute Stroke Patients with Moderate to Severe Pre-Stroke Disability
Background and Purpose Studies on mechanical thrombectomy (MT) in acute ischemic stroke (AIS) patients with preexisting disability are limited. We aimed to compare the outcomes of MT versus best medical treatment (BMT) in these patients. Methods In the nationwide Austrian registry and Swiss monocent...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Korean Stroke Society
2022-09-01
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| Series: | Journal of Stroke |
| Subjects: | |
| Online Access: | http://www.j-stroke.org/upload/pdf/jos-2022-00906.pdf |
| _version_ | 1828726192328409088 |
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| author | Marek Sykora Patrik Michel Davide Strambo Stefan Krebs Julia Ferrari Alexandra Posekany Dominika Mikšová Konstantin Hermann Thomas Gattringer Elke Gizewski Hannes Deutschmann Christian Neumann Wilfried Lang |
| author_facet | Marek Sykora Patrik Michel Davide Strambo Stefan Krebs Julia Ferrari Alexandra Posekany Dominika Mikšová Konstantin Hermann Thomas Gattringer Elke Gizewski Hannes Deutschmann Christian Neumann Wilfried Lang |
| author_sort | Marek Sykora |
| collection | DOAJ |
| description | Background and Purpose Studies on mechanical thrombectomy (MT) in acute ischemic stroke (AIS) patients with preexisting disability are limited. We aimed to compare the outcomes of MT versus best medical treatment (BMT) in these patients. Methods In the nationwide Austrian registry and Swiss monocentric registry, we identified 462 AIS patients with pre-stroke disability (modified Rankin Scale [mRS] score ≥3) and acute large vessel occlusion. The primary outcome was returning to pre-stroke mRS or better at 3 months. Secondary outcomes were early neurological improvement (National Institutes of Health Stroke Scale score improvement ≥8 at 24 to 48 hours), 3-month mortality, and symptomatic intracerebral hemorrhage (sICH). Multivariable regression models and propensity score matching (PSM) were used for statistical analyses. Results Compared with the BMT group (n=175), the MT group (n=175) had younger age, more severe strokes, and lower pre-stroke mRS, but similar proportion of receiving intravenous thrombolysis. MT was associated with higher odds of returning to baseline mRS or better at 3 months (adjusted odds ratio [aOR], 2.5; 95% confidence interval [CI], 1.39 to 4.47), early neurological improvement (aOR, 2.62; 95% CI, 1.41 to 4.88), and lower risk of 3-month mortality (aOR, 0.29; 95% CI, 0.18 to 0.49). PSM analysis showed similar findings. MT was not associated with an increased risk of sICH (4.0% vs. 2.1% in all patients; 4.2% vs. 2.4% in the PSM cohort). Conclusions MT in patients with pre-stroke mRS ≥3 might improve the 3-month outcomes and short-term neurological impairment, suggesting that pre-stroke disability alone should not be a reason to withhold MT, but that individual case-by-case decisions may be more appropriate. |
| first_indexed | 2024-04-12T13:38:30Z |
| format | Article |
| id | doaj.art-a7b17e3f56b346f9ae3ddcfc8aab5aaf |
| institution | Directory Open Access Journal |
| issn | 2287-6391 2287-6405 |
| language | English |
| last_indexed | 2024-04-12T13:38:30Z |
| publishDate | 2022-09-01 |
| publisher | Korean Stroke Society |
| record_format | Article |
| series | Journal of Stroke |
| spelling | doaj.art-a7b17e3f56b346f9ae3ddcfc8aab5aaf2022-12-22T03:30:55ZengKorean Stroke SocietyJournal of Stroke2287-63912287-64052022-09-0124339640310.5853/jos.2022.00906452Mechanical Thrombectomy in Acute Stroke Patients with Moderate to Severe Pre-Stroke DisabilityMarek Sykora0Patrik Michel1Davide Strambo2Stefan Krebs3Julia Ferrari4Alexandra Posekany5Dominika Mikšová6Konstantin Hermann7Thomas Gattringer8Elke Gizewski9Hannes Deutschmann10Christian Neumann11Wilfried Lang12 Department of Neurology, St. John’s Hospital, Vienna, Austria Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland Department of Neurology, St. John’s Hospital, Vienna, Austria Department of Neurology, St. John’s Hospital, Vienna, Austria Austrian National Public Health Institute (Gesundheit Osterreich GmbH)/The Austrian National Institute for Quality in Health Care (Bundesinstitut fur Qualitat im Gesundheitswesen, BIQG), Vienna, Austria Austrian National Public Health Institute (Gesundheit Osterreich GmbH)/The Austrian National Institute for Quality in Health Care (Bundesinstitut fur Qualitat im Gesundheitswesen, BIQG), Vienna, Austria Medical Faculty, Sigmund Freud University Vienna, Vienna, Austria Department of Neurology, Medical University of Graz, Graz, Austria Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria Department of Radiology, St. John’s Hospital, Vienna, Austria Department of Neurology, St. John’s Hospital, Vienna, AustriaBackground and Purpose Studies on mechanical thrombectomy (MT) in acute ischemic stroke (AIS) patients with preexisting disability are limited. We aimed to compare the outcomes of MT versus best medical treatment (BMT) in these patients. Methods In the nationwide Austrian registry and Swiss monocentric registry, we identified 462 AIS patients with pre-stroke disability (modified Rankin Scale [mRS] score ≥3) and acute large vessel occlusion. The primary outcome was returning to pre-stroke mRS or better at 3 months. Secondary outcomes were early neurological improvement (National Institutes of Health Stroke Scale score improvement ≥8 at 24 to 48 hours), 3-month mortality, and symptomatic intracerebral hemorrhage (sICH). Multivariable regression models and propensity score matching (PSM) were used for statistical analyses. Results Compared with the BMT group (n=175), the MT group (n=175) had younger age, more severe strokes, and lower pre-stroke mRS, but similar proportion of receiving intravenous thrombolysis. MT was associated with higher odds of returning to baseline mRS or better at 3 months (adjusted odds ratio [aOR], 2.5; 95% confidence interval [CI], 1.39 to 4.47), early neurological improvement (aOR, 2.62; 95% CI, 1.41 to 4.88), and lower risk of 3-month mortality (aOR, 0.29; 95% CI, 0.18 to 0.49). PSM analysis showed similar findings. MT was not associated with an increased risk of sICH (4.0% vs. 2.1% in all patients; 4.2% vs. 2.4% in the PSM cohort). Conclusions MT in patients with pre-stroke mRS ≥3 might improve the 3-month outcomes and short-term neurological impairment, suggesting that pre-stroke disability alone should not be a reason to withhold MT, but that individual case-by-case decisions may be more appropriate.http://www.j-stroke.org/upload/pdf/jos-2022-00906.pdfthrombectomystrokepre-strokedisabilityhandicappedoutcome study |
| spellingShingle | Marek Sykora Patrik Michel Davide Strambo Stefan Krebs Julia Ferrari Alexandra Posekany Dominika Mikšová Konstantin Hermann Thomas Gattringer Elke Gizewski Hannes Deutschmann Christian Neumann Wilfried Lang Mechanical Thrombectomy in Acute Stroke Patients with Moderate to Severe Pre-Stroke Disability Journal of Stroke thrombectomy stroke pre-stroke disability handicapped outcome study |
| title | Mechanical Thrombectomy in Acute Stroke Patients with Moderate to Severe Pre-Stroke Disability |
| title_full | Mechanical Thrombectomy in Acute Stroke Patients with Moderate to Severe Pre-Stroke Disability |
| title_fullStr | Mechanical Thrombectomy in Acute Stroke Patients with Moderate to Severe Pre-Stroke Disability |
| title_full_unstemmed | Mechanical Thrombectomy in Acute Stroke Patients with Moderate to Severe Pre-Stroke Disability |
| title_short | Mechanical Thrombectomy in Acute Stroke Patients with Moderate to Severe Pre-Stroke Disability |
| title_sort | mechanical thrombectomy in acute stroke patients with moderate to severe pre stroke disability |
| topic | thrombectomy stroke pre-stroke disability handicapped outcome study |
| url | http://www.j-stroke.org/upload/pdf/jos-2022-00906.pdf |
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