Mechanical Thrombectomy in Patients With Ischemic Stroke With Prestroke Disability

Salwi, Sanjana; Cutting, Shawna; Salgado, Alan D.; Espaillat, Kiersten; Fusco, Matthew R.; Froehler, Michael T.; Chitale, Rohan; Kirshner, Howard S.; Schrag, Matthew; Jasne, Adam; Burton, Tina; MacGrory, Brian; Saad, Ali; Jayaraman, Mahesh; Madsen, Tracy E.; Dakay, Katarina; McTaggart, Ryan; Yaghi, Shadi; Khatri, Pooja; Mistry, Akshitkumar M.; Mistry, Eva

doi:10.1161/strokeaha.119.028246

Cited by 49 publications

(72 citation statements)

References 27 publications

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“…The application of mechanical thrombectomy in the treatment of acute ischemic stroke has been studied for many years. The incidence of satisfactory outcomes in this study was approximately 70%, which is similar to previous studies of acute ischemic stroke caused by occlusion of other arteries (16,17). Furthermore, in agreement with previous studies (18,19), the mortality rate in this study was 17% within 90 days after the procedure.…”

Section: Discussionsupporting

confidence: 92%

The efficacy and risk factors of mechanical thrombectomy for the treatment of vertebrobasilar artery occlusion: a single center study

Yao¹,

Xu²,

Zhou³

et al. 2021

Ann Palliat Med

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Background: The mortality of acute ischemic stroke patients caused by vertebrobasilar artery occlusion (VBAO) is high and mechanical thrombectomy has gradually become a promising treatment for acute ischemic stroke. This study analyzed the efficacy of mechanical thrombectomy and the risk factors associated with poor outcomes in VBAO patients caused by severe local atherosclerotic stenosis.Methods: This retrospective study enrolled patients with acute ischemic stroke caused by VBAO between March 1, 2016 and August 31, 2019. Patient demographic and clinical data were collected retrospectively. All enrolled patients were retrospectively interviewed for at least 3 months. Patients with a modified Rankin scale (mRS) score between 0 and 3 points were defined as having satisfactory outcomes while those with more than 3 points were defined as having unsatisfactory outcomes. In-hospital mortality, the rates of recanalization, and the rates of intracerebral hemorrhage were also recorded. Multivariable logistic regression was used to determine the risk factors of unsatisfactory outcomes in enrolled patients.Results: A total of 65 patients were enrolled in this study with a median age 69.0 (63.0-78.0) years and 48 patients (73.8%) were male. Approximately 50% of patients had a mRS score of 0 or 1 point within 90 days after treatment with mechanical thrombectomy and 14 patients had a mRS score of 6 points. A total of 11 patients died in hospital. Out of the 65 patients, 7 required recanalization and 9 patients suffered from intracerebral hemorrhage. Multivariate logistic regression analysis showed that older age, lower baseline posterior circulation acute stroke prognosis early CT score (pcASPECTS), higher baseline National Institutes of Health stroke scale (NIHSS) score, and residual stenosis were independent risk factors of both unsatisfactory outcomes and mortality of VBAO patients.Conclusions: This study confirmed the important role of mechanical thrombectomy in the treatment of acute ischemic stroke caused by VBAO and may provide some guidance for improving the prognosis of patients.

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Section: Discussionsupporting

confidence: 92%

The efficacy and risk factors of mechanical thrombectomy for the treatment of vertebrobasilar artery occlusion: a single center study

Yao¹,

Xu²,

Zhou³

et al. 2021

Ann Palliat Med

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“…These results emphasize that pre-stroke dependent patients have a higher risk of suffering death after ET, likely reflecting higher rates of comorbidities in this patient population. Although not the focus of our study, but in support of this notion, the prestroke dependent patients had significantly more comorbidities than independent patients in the aforementioned MR Clean Registry and analysis of the two comprehensive stroke centers (8,9). Aside from a higher disease burden caused by preexisting comorbidities, the dependent patients are more likely to have other complications than SICH.…”

Section: Discussionsupporting

confidence: 55%

“…Since pre-stroke disability will continue to rise in the coming years (7), the potential impact of ET on outcome in patients with prior disabilities has received increased attention. In fact, several recent case series as well as an analysis of the MR Clean Registry have revealed favorable functional and procedural outcome rates after ET in patients with prior disabilities compared to those without pre-stroke disability (8)(9)(10)(11)), yet all of these studies lacked a control group, such that the true treatment effect of ET in pre-stroke disabled patients is unknown.…”

Section: Introductionmentioning

confidence: 99%

Endovascular Therapy vs. Thrombolysis in Pre-stroke Dependent Patients With Large Vessel Occlusions Within the Anterior Circulation

et al. 2021

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Background: In the past few years, several randomized trials have clearly shown that endovascular treatment (ET) in addition to intravenous thrombolysis (IVT) is superior to IVT alone in patients with proximal cerebral arterial occlusions. However, the effectiveness of ET in pre-stroke dependent patients (modified Rankin Scale ≥3) is uncertain.Methods: Using our prospectively obtained stroke database, we analyzed the impact of pre-stroke dependence on the rates of poor outcome (discharge mRS 5–6), in-hospital death, infarct sizes, and symptomatic intracranial hemorrhage (SICH) in patients with distal intracranial carotid artery M1 and M2 occlusions during two time periods.Results: From 1/2008 to 10/2012, a total of 544 patients (455 without and 89 with dependence) were treated with IVT, and from 11/2012 to 12/2019 a total of 1,061 patients (919 without and 142 with dependence) received ET (with or without IVT). Irrespective of the treatment modality, the dependent patients had significantly higher rates of poor outcome (55 vs. 32%, p < 0.001), death (24 vs. 11%; p < 0.001), or SICH (8.2 vs. 3.6%, p < 0.01) than independent patients. In dependent patients, ET significantly reduced the rates of poor outcome (49 vs. 64%, p < 0.01) and led to smaller infarcts, whereas the rates of in-hospital death (25 vs. 22%; p = 0.6) or SICH (8.5 vs. 7.9%, p = 0.9) were comparable between both treatment modalities.Conclusions: Compared with IVT, ET avoids poor outcome and leads to smaller infarcts in dependent patients. However, the overall high rates of poor outcome in this patient population stress the importance to perform decisions based on a case-by-case basis.

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“…However, patients who underwent thrombectomy in the NIS were older, had a higher proportion aged 80 years or older, and had more comorbidities than those who underwent thrombectomy in HERMES. Previous studies have shown higher mortality and less favorable outcomes after thrombectomy in patients aged 80 years or older (24,25) and in patients with worse premorbid disability (32). However, fewer ICA strokes in the NIS thrombectomy cohort would have favored better outcomes in this group.…”

Section: Rates Reasons and Risks For Readmissionmentioning

confidence: 96%

Endovascular Thrombectomy after Large-Vessel Ischemic Stroke: Utilization, Outcomes, and Readmissions across the United States

et al. 2021

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E ach year approximately 795 000 people experience a new or recurrent stroke, the fifth leading cause of death and the most common source of permanent disability in the United States. Ischemic stroke is responsible for 87% of all strokes (1). The first endovascular clot retrieval device was approved by the U.S. Food and Drug Administration in 2004, and endovascular treatment of patients with stroke evolved substantially during the next decade (2). In 2015, investigators in five multicenter randomized controlled clinical trials (3-7) reported a marked benefit for endovascular thrombectomy in the management of acute ischemic stroke (AIS) secondary to large-vessel occlusion. Shortly thereafter, the American Heart Association-American Stroke Association guidelines for management of AIS were revised to recommend endovascular thrombectomy in selected patients with proximal anterior circulation occlusion who presented within 6 hours from the time last known to be well (8). The impact of this landmark change in acute stroke management remains less studied at the population level. We therefore used the most recently available (2016-2017) National Inpatient Sample (NIS) and Nationwide Readmissions Database (NRD) data sets to examine realworld thrombectomy rates, adverse events, inpatient outcomes, and readmissions across the United States in the 2 years following large-scale adoption of thrombectomy in AIS. Materials and Methods Databases The NIS database and NRD contain all-payer data on hospital inpatient stays from states participating in the Healthcare Cost and Utilization Project (HCUP) sponsored by the Agency for Healthcare Research and Quality

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Mechanical Thrombectomy in Patients With Ischemic Stroke With Prestroke Disability

Cited by 49 publications

References 27 publications

The efficacy and risk factors of mechanical thrombectomy for the treatment of vertebrobasilar artery occlusion: a single center study

The efficacy and risk factors of mechanical thrombectomy for the treatment of vertebrobasilar artery occlusion: a single center study

Endovascular Therapy vs. Thrombolysis in Pre-stroke Dependent Patients With Large Vessel Occlusions Within the Anterior Circulation

Endovascular Thrombectomy after Large-Vessel Ischemic Stroke: Utilization, Outcomes, and Readmissions across the United States

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