Benefit of successful reperfusion achieved by endovascular thrombectomy for patients with ischemic stroke and moderate pre-stroke disability (mRS 3): results from the MR CLEAN Registry

Abstract

BackgroundPre-stroke dependent patients (modified Rankin Scale score (mRS) ≥3) were excluded from most trials on endovascular treatment (EVT) for acute ischemic stroke (AIS) in the anterior circulation. Therefore, little evidence exists for EVT in those patients. We aimed to investigate the safety and benefit of EVT in pre-stroke patients with mRS score 3.MethodsWe used data from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic stroke in the Netherlands (MR CLEAN) Registry. All patients treated with EVT for anterior circulation AIS with pre-stroke mRS 3 were included. We assessed causes for dependence and compared patients with successful reperfusion (defined as expanded Thrombolysis in Cerebral Ischemia scale (eTICI) 2b–3) to patients without successful reperfusion. We used regression analyses with pre-specified adjustments. Our primary outcome was 90-day mRS 0–3 (functional improvement or return to baseline).ResultsA total of 192 patients were included, of whom 82 (43%) had eTICI <2b and 108 (56%) eTICI ≥2b. The median age was 80 years (IQR 73–87). Fifty-one of the 192 patients (27%) suffered from previous stroke and 36/192 (19%) had cardiopulmonary disease. Patients with eTICI ≥2b more often returned to their baseline functional state or improved (n=26 (26%) vs n=15 (19%); adjusted odds ratio (aOR) 2.91 (95% CI 1.08 to 7.82)) and had lower mortality rates (n=49 (49%) vs n=50 (64%); aOR 0.42 (95% CI 0.19 to 0.93)) compared with patients with eTICI <2b.ConclusionsAlthough patients with AIS with pre-stroke mRS 3 comprise a heterogenous group of disability causes, we observed improved outcomes when patients achieved successful reperfusion after EVT.

Outcomes of patients with pre-existing disability managed by mobile stroke units: A sub-analysis of the BEST-MSU study

“…As expected, PD patients were older, had worse baseline mRS and NIHSS, were less frequently residing at home, and had more dementia and multiple comorbidities compared to ND patients, similar to previous observations. 15–19,22–25 We also found that they were less often men, and less frequently Hispanic which may reflect a lower propensity to alert 911 for PD patients in these demographic groups. Patients with PD also received slower thrombolysis, even among those managed on the MSU, and slower and less frequent EVT compared to ND patients, indicating potential areas for quality improvement, though these findings are probably due in part to the greater complexity of making treatment decisions in patients with disabilities and advanced age.…”

Endovascular thrombectomy in acute ischemic stroke patients with prestroke disability (mRS ≥2): A systematic review and meta-analysis

“…After reviewing the remaining 33 full-text articles, 12 articles ( 15 – 26 ) met the inclusion criteria. In addition, one relevant study ( 27 ) was identified from the updated search. Finally, 13 articles were included in this systematic review and meta-analysis.…”

Association of tirofiban with improvement of functional outcomes of direct thrombectomy for acute anterior circulation occlusion: a retrospective, nonrandomized, multicenter, real-world study

“…[1][2][3] Endovascular therapy has become increasingly recognized as the standard approach for strokes induced by large-vessel occlusion (LVO), particularly in the anterior circulation. 4 Despite a successful EVT recanalization rate of up to 90%, favorable outcomes ABBREVIATIONS AIS = acute ischemic stroke; EVT = endovascular thrombectomy; LVO = large-vessel occlusion; MCA = middle cerebral artery; mRS = modified Rankin Scale; mTICI = modified Thrombolysis in Cerebral Infarction; NIHSS = National Institutes of Health Stroke Scale; sICH = symptomatic intracerebral hemorrhage.…”