From Three-Months to Five-Years: Sustaining Long-Term Benefits of Endovascular Therapy for Ischemic Stroke

Abstract

Background and Purpose: During the months and years post-stroke, treatment benefits from endovascular therapy (EVT) may be magnified by disability-related differences in morbidity/mortality or may be eroded by recurrent strokes and non-stroke-related disability/mortality. Understanding the extent to which EVT benefits may be sustained at 5 years, and the factors influencing this outcome, may help us better promote the sustenance of EVT benefits until 5 years post-stroke and beyond.Methods: In this review, undertaken 5 years after EVT became the standard of care, we searched PubMed and EMBASE to examine the current state of the literature on 5-year post-stroke outcomes, with particular attention to modifiable factors that influence outcomes between 3 months and 5 years post-EVT.Results: Prospective cohorts and follow-up data from EVT trials indicate that 3-month EVT benefits will likely translate into lower 5-year disability, mortality, institutionalization, and care costs and higher quality of life. However, these group-level data by no means guarantee maintenance of 3-month benefits for individual patients. We identify factors and associated “action items” for stroke teams/systems at three specific levels (medical care, individual psychosocioeconomic, and larger societal/environmental levels) that influence the long-term EVT outcome of a patient. Medical action items include optimizing stroke rehabilitation, clinical follow-up, secondary stroke prevention, infection prevention/control, and post-stroke depression care. Psychosocioeconomic aspects include addressing access to primary care, specialist clinics, and rehabilitation; affordability of healthy lifestyle choices and preventative therapies; and optimization of family/social support and return-to-work options. High-level societal efforts include improving accessibility of public/private spaces and transportation, empowering/engaging persons with disability in society, and investing in treatments/technologies to mitigate consequences of post-stroke disability.Conclusions: In the longtime horizon from 3 months to 5 years, several factors in the medical and societal spheres could negate EVT benefits. However, many factors can be leveraged to preserve or magnify treatment benefits, with opportunities to share responsibility with widening circles of care around the patient.

Age and Stroke Severity Matter Most for Clinical Outcome in Acute Arteriosclerotic Tandem Lesions

“…However, procedural and imaging features only showed a limited impact on favorable outcome rates within the 3-month FU period. These findings indicated that, for a longer time horizon post-stroke survival, age, comorbidities, and physical fitness are of the utmost importance [22], and periprocedural features are less so. Further, as currently reported for common LVO AIS patients [23], very old TL patients (>79 years) were much more likely to die within the follow-up period, which raises the question of how aggressively an EVT treatment should be utilized in this group of patients [24].…”

Effect of massive cerebellar infarction on the outcomes of patients with acute basilar artery occlusion during hospitalization after endovascular treatment: A retrospective study

“…Although some patients' short-term outcomes have improved thanks to EVT, nothing is known about how this surgery would affect patients' quality of life and level of handicap over the long term. [10,11] The usefulness of EVT in preventing impairment and enhancing quality of life in ABAO patients over the long term should be evaluated by additional research. Several factors, including age, stroke severity, time from reperfusion to onset, infarct volume before treatment, thrombosis length, etiology, and collateral circulation, may affect the clinical prognosis of ABAO patients after EVT.…”

Efficacy of Cerebrolysin Treatment as an Add-On Therapy to Mechanical Thrombectomy in Patients With Acute Ischemic Stroke Due to Large Vessel Occlusion: Study Protocol for a Prospective, Open Label, Single-Center Study With 12 Months of Follow-Up

“…Beside of early outcomes, MT also results in favorable outcomes at long-term follow-up compared to standard medical treatment alone. However, prospective follow-up data from MT trials indicate that 3-month MT benefits will likely translate into lower long-term mortality and disability (with about 31–36% of functionally disabled patients 5 years post-stroke), but these group-level data by no means guarantee maintenance of 3-month positive outcome for individual patients ( 9 ). Several critical factors operate in the post-stroke period that can influence long-term recovery of the patient, and the benefits depend on continuing and optimizing stroke prevention, access to rehabilitation, and post-stroke depression care.…”