[en] [en] BACKGROUND: Patients with pre-stroke disability, defined as a modified Rankin Scale (mRS) ≥3, were excluded from most trials of endovascular thrombectomy (EVT) for acute stroke. We sought to evaluate the prognostic factors associated with favorable outcome in stroke patients with known disability undergoing EVT, and the impact of successful reperfusion.
METHODS: Consecutive acute stroke patients with pre-stroke disability, undergoing EVT, were retrospectively collected between 2016 to 2019 from a Canadian cohort and a multicenter French cohort (Endovascular Treatment in Ischemic Stroke registry-ETIS). Favorable outcome was defined as an mRS equal to pre-stroke mRS. Patients achieving successful reperfusion (defined as a modified Thrombolysis in Cerebral Infarction score of 2b/3) were compared with patients without successful reperfusion to determine if successful EVT was associated with better functional outcomes.
RESULTS: Among 6220 patients treated with EVT, 280 (4.5%) patients with a pre-stroke mRS ≥3 were included. Sixty-one patients (21.8%) had a favorable outcome and 146 (52.1%) died at 3 months. Patients with successful reperfusion had a higher proportion of favorable 90-day mRS (27.6% versus 19.6%, p = 0.025) and a lower mortality (48.3% versus 69.6%, p = 0.008) than patients without successful reperfusion. After adjusting for baseline prognostic factors, successful reperfusion defined by TICI ≥2b was associated with favorable functional outcome (OR 3.16 CI95% [1.11-11.5]; p 0.048).
CONCLUSION: In patients with pre-stroke disability, successful reperfusion is associated with a greater proportion of favorable outcome and lower mortality.
Disciplines :
Neurology
Author, co-author :
Ducroux, Célina; Department of Neurosciences, Faculté de médecine, Université de Montréal, Montréal, QC, Canada, Department of Medicine (Neurology), Centre Hospitalier de l'Université de Montréal, 900 rue St-Denis, Bureau R04-758, Montréal, QC H2X 0A9, Canada
Derex, Laurent; Department of Neurology, Stroke Center, Neurological Hospital, Hospices Civils de Lyon, University of Lyon, France, Research on Healthcare Performance (RESHAPE), INSERM U1290, University Claude Bernard Lyon 1, Lyon, France
Nourredine, Mikaïl; Department of Research and Epidemiology, Pôle de Santé Publique, Hospices Civils de Lyon, Lyon, France, Department of pharmaco-toxicology, Hospices Civils de Lyon, Lyon, France
Haesebaert, Julie; Department of Research and Epidemiology, Pôle de Santé Publique, Hospices Civils de Lyon, Lyon, France, Department of pharmaco-toxicology, Hospices Civils de Lyon, Lyon, France
Buisson, Marielle; Clinical Investigation Center, INSERM 1407, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
Alesefir, Walid; Department of Neurosciences, Faculté de médecine, Université de Montréal, Montréal, QC, Canada, Department of Medicine (Neurology), Centre Hospitalier de l'Université de Montréal, 900 rue St-Denis, Bureau R04-758, Montréal, QC H2X 0A9, Canada
Boisseau, William; Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
Daneault, Nicole; Department of Neurosciences, Faculté de médecine, Université de Montréal, Montréal, QC, Canada, Department of Medicine (Neurology), Centre Hospitalier de l'Université de Montréal, 900 rue St-Denis, Bureau R04-758, Montréal, QC H2X 0A9, Canada, Neurovascular Group, Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
Deschaintre, Yan; Department of Neurosciences, Faculté de médecine, Université de Montréal, Montréal, QC, Canada, Department of Medicine (Neurology), Centre Hospitalier de l'Université de Montréal, 900 rue St-Denis, Bureau R04-758, Montréal, QC H2X 0A9, Canada, Neurovascular Group, Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
Diestro, Jose Danilo B; Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
Eker, Omer; Department of Neuroradiology, Neurological Hospital, Hospices Civils de Lyon, Lyon, France
Eneling, Johanna; Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
Gioia, Laura C; Department of Neurosciences, Faculté de médecine, Université de Montréal, Montréal, QC, Canada, Department of Medicine (Neurology), Centre Hospitalier de l'Université de Montréal, 900 rue St-Denis, Bureau R04-758, Montréal, QC H2X 0A9, Canada, Neurovascular Group, Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
Iancu, Daniella; Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
Jacquin, Grégory; Department of Neurosciences, Faculté de médecine, Université de Montréal, Montréal, QC, Canada, Department of Medicine (Neurology), Centre Hospitalier de l'Université de Montréal, 900 rue St-Denis, Bureau R04-758, Montréal, QC H2X 0A9, Canada, Neurovascular Group, Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
Odier, Céline; Department of Neurosciences, Faculté de médecine, Université de Montréal, Montréal, QC, Canada, Department of Medicine (Neurology), Centre Hospitalier de l'Université de Montréal, 900 rue St-Denis, Bureau R04-758, Montréal, QC H2X 0A9, Canada, Neurovascular Group, Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
Stapf, Christian; Department of Neurosciences, Faculté de médecine, Université de Montréal, Montréal, QC, Canada, Department of Medicine (Neurology), Centre Hospitalier de l'Université de Montréal, 900 rue St-Denis, Bureau R04-758, Montréal, QC H2X 0A9, Canada, Neurovascular Group, Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
Raymond, Jean; Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
Roy, Daniel; Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
Weill, Alain; Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
Lapergue, Bertrand; Department of Neurology, Foch Hospital, Suresnes, France
Poppe, Alexandre Y; Department of Neurosciences, Faculté de médecine, Université de Montréal, Montréal, QC, Canada, Department of Medicine (Neurology), Centre Hospitalier de l'Université de Montréal, 900 rue St-Denis, Bureau R04-758, Montréal, QC H2X 0A9, Canada, Neurovascular Group, Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada. Electronic address: alexandre.poppe.med@ssss.gouv.qc.ca
ETIS (Endovascular Treatment in Ischemic Stroke) Investigators
Delvoye, François ; Université de Liège - ULiège > Département des sciences cliniques
Goyal, M., Menon, B.K., van Zwam, W.H., et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 387 (2016), 1723–1731.
Pinguet, V., Duloquin, G., Thibault, T., et al. Pre-existing brain damage and association between severity and prior cognitive impairment in ischemic stroke patients. J Neuroradiol, 2022.
Berkhemer, O.A., Fransen, P.S., Beumer, D., et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 372 (2015), 11–20.
Goldhoorn, R.B., Verhagen, M., Dippel, D.W.J., et al. Safety and outcome of endovascular treatment in prestroke-dependent patients. Stroke 49 (2018), 2406–2414.
Powers, W.J., Rabinstein, A.A., Ackerson, T., et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 50 (2019), e344–e418.
Boulanger, J.M., Lindsay, M.P., Gubitz, G., et al. Canadian stroke best practice recommendations for acute stroke management: prehospital, emergency department, and acute inpatient stroke care, 6th edition, update 2018. Int J Stroke 13 (2018), 949–984.
Gensicke, H., Strbian, D., Zinkstok, S.M., et al. Intravenous thrombolysis in patients dependent on the daily help of others before stroke. Stroke 47 (2016), 450–456.
Salwi, S., Cutting, S., Salgado, A.D., et al. Mechanical thrombectomy in patients with ischemic stroke with prestroke disability. Stroke 51 (2020), 1539–1545.
Seker, F., Pfaff, J., Schonenberger, S., et al. Clinical outcome after thrombectomy in patients with stroke with premorbid modified rankin scale scores of 3 and 4: a cohort study with 136 patients. AJNR Am J Neuroradiol 40 (2019), 283–286.
Oesch, L., Arnold, M., Bernasconi, C., et al. Impact of pre-stroke dependency on outcome after endovascular therapy in acute ischemic stroke. J Neurol 268 (2021), 541–548.
Regenhardt, R.W., Young, M.J., Etherton, M.R., et al. Toward a more inclusive paradigm: thrombectomy for stroke patients with pre-existing disabilities. J Neurointerv Surg 13:10 (2020), 865–868.
Suttorp, M.M., Siegerink, B., Jager, K.J., et al. Graphical presentation of confounding in directed acyclic graphs. Nephrol Dial Transplant 30 (2015), 1418–1423.
Goda, T., Oyama, N., Kitano, T., et al. Prestroke conditions of acute ischemic stroke patients are associated with functional outcome after mechanical thrombectomy. J Stroke Cerebrovasc Dis, 29, 2020, 104540.
de Havenon, A., Castonguay, A., Nogueira, R., et al. Prestroke disability and outcome after thrombectomy for emergent anterior circulation large vessel occlusion stroke. Neurology 97:19 (2021), e1914–e1919.
Millan, M., Ramos-Pachon, A., Dorado, L., et al. Predictors of functional outcome after thrombectomy in patients with prestroke disability in clinical practice. Stroke 53:3 (2021), 845–854 STROKEAHA121034960.
Finlayson, O., Kapral, M., Hall, R., et al. Risk factors, inpatient care, and outcomes of pneumonia after ischemic stroke. Neurology 77 (2011), 1338–1345.
Young, M.J., Regenhardt, R.W., Leslie-Mazwi, T.M., et al. Disabling stroke in persons already with a disability: ethical dimensions and directives. Neurology 94 (2020), 306–310.
Shamy, M.C., Jaigobin, CS., The complexities of acute stroke decision-making: a survey of neurologists. Neurology 81 (2013), 1130–1133.
van den Berg, L.A., Berkhemer, O.A., Fransen, P.S.S., et al. Economic evaluation of endovascular treatment for acute ischemic stroke. Stroke 53:3 (2021), 968–975 STROKEAHA121034599.
Quinn, T.J., Dawson, J., Walters, M.R., et al. Exploring the reliability of the modified rankin scale. Stroke 40 (2009), 762–766.
