Sistema de Salut de Catalunya
Institut Català de la Salut
[Tanaka K] Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan. Stroke Center, Kindai University Hospital, Osakasayama, Japan. [Yamagami H] Division of Stroke Prevention and Treatment, Institute of Medicine, University of Tsukuba, Tsukuba, Japan. [Qureshi MM] Department of Radiology, Radiation Oncology, Boston Medical Center, Boston, MA, USA. [Uchida K] Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan. [Siegler JE] Department of Neurology, University of Chicago, Chicago, IL, USA. [Nogueira RG] Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. [Olive-Gadea M, Requena M, Ribo M] Servei de Neurologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain
Vall d'Hebron Barcelona Hospital Campus
2024-06-07T12:20:50Z
2024-06-07T12:20:50Z
2024-05
Endovascular therapy; Ischemic stroke; Reperfusion
Terapia endovascular; Ictus isquémico; Reperfusión
Teràpia endovascular; Ictus isquèmic; Reperfusió
Background and Purpose We compared the outcomes of endovascular therapy (EVT) in an extended time window in patients with large-vessel occlusion (LVO) between patients with and without pre-stroke disability. Methods In this prespecified analysis of the multinational CT for Late Endovascular Reperfusion study (66 participating sites, 10 countries between 2014 and 2022), we analyzed data from patients with acute ischemic stroke with a pre-stroke modified Rankin Scale (mRS) score of 0-4 and LVO who underwent EVT 6-24 hours from the time last seen well. The primary outcome was the composite of functional independence (FI; mRS score 0-2) or return to the pre-stroke mRS score (return of Rankin, RoR) at 90 days. Outcomes were compared between patients with pre-stroke disability (pre-stroke mRS score 2-4) and those without (mRS score 0-1). Results A total of 2,231 patients (median age, 72 years; median National Institutes of Health Stroke Scale score, 16) were included in the present analysis. Of these, 564 (25%) had pre-stroke disability. The primary outcome (FI or RoR) was observed in 30.7% of patients with pre-stroke disability (FI, 16.5%; RoR, 30.7%) compared to 44.1% of patients without (FI, 44.1%; RoR, 13.0%) (P<0.001). In multivariable logistic regression analysis with inverse probability of treatment weighting, pre-stroke disability was not associated with significantly lower odds of achieving FI or RoR (adjusted odds ratio 0.73, 95% confidence interval 0.43-1.25). Symptomatic intracranial hemorrhage occurred in 6.3% of both groups (P=0.995). Conclusion A considerable proportion of patients with late-presenting LVO and pre-stroke disability regained pre-stroke mRS scores after EVT. EVT may be appropriate for patients with pre-stroke disability presenting in the extended time window.
This study was supported by the Society of Vascular and Interventional Neurology, Japan Agency for Medical Research and Development, Japanese Society for Neuroendovascular Therapy, Ministry of Health, Labor, and Welfare of Japan, Takeda Science Foundation, and Medtronic.
Article
Published version
English
Malalties cerebrovasculars - Tractament; Fibrinolítics - Ús terapèutic; Avaluació de resultats (Assistència sanitària); Trombosi - Cirurgia; Persones amb discapacitat; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Surgical Procedures, Operative::Cardiovascular Surgical Procedures::Vascular Surgical Procedures::Endovascular Procedures; DISEASES::Nervous System Diseases::Central Nervous System Diseases::Brain Diseases::Cerebrovascular Disorders::Stroke; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Diagnosis::Prognosis::Treatment Outcome; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Drug Therapy::Thrombolytic Therapy; NAMED GROUPS::Persons::Disabled Persons; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::intervenciones quirúrgicas::procedimientos quirúrgicos cardiovasculares::procedimientos quirúrgicos vasculares::procedimientos endovasculares; ENFERMEDADES::enfermedades del sistema nervioso::enfermedades del sistema nervioso central::enfermedades cerebrales::trastornos cerebrovasculares::accidente cerebrovascular; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::diagnóstico::pronóstico::resultado del tratamiento; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::farmacoterapia::tratamiento trombolítico; DENOMINACIONES DE GRUPOS::personas::personas con discapacidad
Korean Stroke Society
Journal of Stroke;26(2)
https://doi.org/10.5853/jos.2023.04259
Attribution-NonCommercial 4.0 International
http://creativecommons.org/licenses/by-nc/4.0/
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