Endovascular Therapy for Acute Ischemic Stroke in Patients With Prestroke Disability
Background Outcomes after stroke as a result of large‐vessel occlusion in patients with prestroke disability were compared between endovascular therapy (EVT) and medical management. Methods and Results Of 2420 patients with acute stroke with large‐vessel occlusion in a prospective, multicenter, nati...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-08-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.020783 |
| _version_ | 1818555621632376832 |
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| author | Kanta Tanaka Hiroshi Yamagami Takeshi Yoshimoto Kazutaka Uchida Takeshi Morimoto Kazunori Toyoda Nobuyuki Sakai Shinichi Yoshimura |
| author_facet | Kanta Tanaka Hiroshi Yamagami Takeshi Yoshimoto Kazutaka Uchida Takeshi Morimoto Kazunori Toyoda Nobuyuki Sakai Shinichi Yoshimura |
| author_sort | Kanta Tanaka |
| collection | DOAJ |
| description | Background Outcomes after stroke as a result of large‐vessel occlusion in patients with prestroke disability were compared between endovascular therapy (EVT) and medical management. Methods and Results Of 2420 patients with acute stroke with large‐vessel occlusion in a prospective, multicenter, nationwide registry in Japan, patients with prestroke modified Rankin Scale scores 2 to 4 with occlusion of the internal carotid artery, or M1 of the middle cerebral artery were analyzed. The primary effectiveness outcome was the favorable outcome, defined as return to at least the prestroke modified Rankin Scale score at 3 months. Safety outcomes included symptomatic intracranial hemorrhage. A total of 339 patients (237 women; median 85 [interquartile range (IQR), 79–89] years of age; median prestroke modified Rankin Scale score of 3 [IQR, 2–4]) were analyzed. EVT was performed in 175 patients (51.6%; mechanical thrombectomy, n=139). The EVT group was younger (p<0.01) and had lower prestroke modified Rankin Scale scores (p<0.01) than the medical management group. The favorable outcome was seen in 28.0% of the EVT group and in 10.9% of the medical management group (p<0.01). EVT was associated with the favorable outcome (adjusted odds ratio, 3.01; 95% CI, 1.55–5.85; mixed effects multivariable model with inverse probability of treatment weighting). Symptomatic intracranial hemorrhage rates were similar between the EVT (4.0%) and medical management (4.3%) groups (p=1.00). Conclusions Patients who underwent EVT showed better functional outcomes than those with medical management. Given proper patient selection, withholding EVT solely on the basis of prestroke disability might not offer the best chance of favorable outcome. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02419794. |
| first_indexed | 2024-12-12T09:56:07Z |
| format | Article |
| id | doaj.art-af7dde4469824aa59c853a65738845bf |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-12T09:56:07Z |
| publishDate | 2021-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-af7dde4469824aa59c853a65738845bf2022-12-22T00:28:08ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-08-01101510.1161/JAHA.121.020783Endovascular Therapy for Acute Ischemic Stroke in Patients With Prestroke DisabilityKanta Tanaka0Hiroshi Yamagami1Takeshi Yoshimoto2Kazutaka Uchida3Takeshi Morimoto4Kazunori Toyoda5Nobuyuki Sakai6Shinichi Yoshimura7Division of Stroke Care Unit National Cerebral and Cardiovascular Center Suita JapanDepartment of Stroke Neurology National Hospital Organization Osaka National Hospital Osaka JapanDivision of Stroke Care Unit National Cerebral and Cardiovascular Center Suita JapanDepartment of Neurosurgery Hyogo College of Medicine Nishinomiya JapanDepartment of Clinical Epidemiology Hyogo College of Medicine Nishinomiya JapanDepartment of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita JapanDepartment of Neurosurgery Kobe City Medical Center General Hospital Kobe JapanDepartment of Neurosurgery Hyogo College of Medicine Nishinomiya JapanBackground Outcomes after stroke as a result of large‐vessel occlusion in patients with prestroke disability were compared between endovascular therapy (EVT) and medical management. Methods and Results Of 2420 patients with acute stroke with large‐vessel occlusion in a prospective, multicenter, nationwide registry in Japan, patients with prestroke modified Rankin Scale scores 2 to 4 with occlusion of the internal carotid artery, or M1 of the middle cerebral artery were analyzed. The primary effectiveness outcome was the favorable outcome, defined as return to at least the prestroke modified Rankin Scale score at 3 months. Safety outcomes included symptomatic intracranial hemorrhage. A total of 339 patients (237 women; median 85 [interquartile range (IQR), 79–89] years of age; median prestroke modified Rankin Scale score of 3 [IQR, 2–4]) were analyzed. EVT was performed in 175 patients (51.6%; mechanical thrombectomy, n=139). The EVT group was younger (p<0.01) and had lower prestroke modified Rankin Scale scores (p<0.01) than the medical management group. The favorable outcome was seen in 28.0% of the EVT group and in 10.9% of the medical management group (p<0.01). EVT was associated with the favorable outcome (adjusted odds ratio, 3.01; 95% CI, 1.55–5.85; mixed effects multivariable model with inverse probability of treatment weighting). Symptomatic intracranial hemorrhage rates were similar between the EVT (4.0%) and medical management (4.3%) groups (p=1.00). Conclusions Patients who underwent EVT showed better functional outcomes than those with medical management. Given proper patient selection, withholding EVT solely on the basis of prestroke disability might not offer the best chance of favorable outcome. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02419794.https://www.ahajournals.org/doi/10.1161/JAHA.121.020783disabilityendovascular therapyoutcomestrokethrombectomy |
| spellingShingle | Kanta Tanaka Hiroshi Yamagami Takeshi Yoshimoto Kazutaka Uchida Takeshi Morimoto Kazunori Toyoda Nobuyuki Sakai Shinichi Yoshimura Endovascular Therapy for Acute Ischemic Stroke in Patients With Prestroke Disability Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease disability endovascular therapy outcome stroke thrombectomy |
| title | Endovascular Therapy for Acute Ischemic Stroke in Patients With Prestroke Disability |
| title_full | Endovascular Therapy for Acute Ischemic Stroke in Patients With Prestroke Disability |
| title_fullStr | Endovascular Therapy for Acute Ischemic Stroke in Patients With Prestroke Disability |
| title_full_unstemmed | Endovascular Therapy for Acute Ischemic Stroke in Patients With Prestroke Disability |
| title_short | Endovascular Therapy for Acute Ischemic Stroke in Patients With Prestroke Disability |
| title_sort | endovascular therapy for acute ischemic stroke in patients with prestroke disability |
| topic | disability endovascular therapy outcome stroke thrombectomy |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.020783 |
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