Patient-Reported Anxiety/Depression After Endovascular Thrombectomy: A post-hoc Analysis of Direct-MT Trial

Abstract

ObjectiveTo analyze the effect of endovascular thrombectomy (EVT) alone vs. EVT after an intravenous (IV) alteplase of ischemic stroke on a patient-reported anxiety/depression, and to identify predictors of patient-reported anxiety/depression by analyzing data from Direct Intraarterial Thrombectomy in Order to Revascularize the patients with Acute Ischemic Stroke with a Large Vessel Occlusion Efficiently in Chinese Tertiary Hospitals: a Multicenter Randomized Clinical Trial (DIRECT-MT).MethodsPatients with acute ischemic stroke (AIS), triggered by a large-vessel occlusion in the anterior circulation, were randomly allocated to undergo an EVT after IV alteplase (combination-therapy group) or an EVT alone (EVT-alone group) at a 1:1 ratio in DIRECT-MT. Patients in both groups were followed up for 90 days (±14 days) after stroke using a structured modified Ranking Scale (mRS), a Barthel Index (BI), and a 5-Dimensional European Quality of Life Scale (EQ-5D-5L). Patients who returned EQ-5D-5L were included. The EQ-5D-5L anxiety/depression dimension was used to analyze the patient-reported anxiety/depression. First, differences in patient-reported anxiety/depression were compared between the combination-therapy group and the EVT-alone group. Then, the baseline and influencing factors between the anxiety/depression group and no anxiety/depression group were analyzed using univariate regression analysis. Finally, variables with p < 0.1 in univariate regression were subjected to multivariable binary regression analysis to screen independent predictors for patient-reported anxiety /depression after ischemic stroke.Results: Five hundred fifteen patients returned the EQ-5D-5L in Direct-MT. Of these patients, 226 (43.88%) reported a level of anxiety/depression, and about 7% reported a severe or extremely severe anxiety/depression. The patient-reported anxiety/depression in the EVT-alone group was significantly higher than that in the combination-therapy group (48.26% vs. 39.45%, p = 0.04). The clinical outcomes were significantly different between the no Anxiety/Depression Group and the anxiety/depression group (mRS at 90 days:2 vs 3, p < 0.001; BI of 95 or 100 at 90 days: 73.36% vs 42.04%, p < 0.001; EQ-5D-5l utility indexes at 90 days:0.96 vs.57, p < 0.001). Logistic regression analysis showed that allocation to thrombolysis before EVT strategy was inversely associated with anxiety/depression [0.61(0.40, 0.94), p = 0.03], an insular cortex ischemia, and National Institute of Health Strocke Scale (NIHSS) at 7 days were positively associated with anxiety/depression [2.04(1.07, 3.90), p = 0.03; 1.07(1.03, 1.12), p < 0.001].ConclusionsPatient-reported anxiety/depression may suggest that there is a benefit to administering intravenous alteplase before EVT. It may also indicate that it is better to provide IV alteplase before EVT, rather than EVT alone according to patient-reported anxiety/depression. Future research should consider not only the motor function impairments but also the patient-reported mental problems as measures of treatment efficacy in patients with stroke (DIRECT-MT ClinicalTrials.gov number, NCT03469206).

A systematic review and meta-analysis of health utility values among patients with ischemic stroke

“…The basic characteristics of the included studies are summarized in Table 1 . A total of 39 identified studies were published between 1999 ( 24 ) and 2022 ( 25 ), with most of studies ( n = 8) ( 26 – 33 ) published in 2017. The included studies covered different regions around the world.…”

“…The included studies covered different regions around the world. Five of the studies were multinational ( 26 , 31 , 34 – 36 ), 18 studies in Europe ( 24 , 27 , 28 , 30 , 32 , 33 , 37 – 48 ), 8 studies in Asia ( 25 , 49 – 55 ), 7 studies in North America ( 29 , 56 – 61 ), and 1 study in Australia ( 62 ). In terms of study design, 22 of the 39 (56.4%) studies were observational, while the rest were randomized controlled studies to assess the effectiveness of treatment.…”

“…In terms of study design, 22 of the 39 (56.4%) studies were observational, while the rest were randomized controlled studies to assess the effectiveness of treatment. In the randomized controlled studies, endovascular treatment (EVT) was the most common therapy ( 25 , 28 , 31 – 33 , 35 , 43 , 54 ). Other treatments included a rehabilitation program, alteplase, citicoline, intravenous tissue plasminogen activator (t-PA), lipid management, and blood pressure management.…”

“…The evaluation methods are presented in Table 2 . For methods applied, three studies ( 40 , 42 , 46 ) did not specify the survey method, while nine studies ( 25 , 28 , 34 , 36 , 44 , 45 , 53 , 54 , 61 ) used more than one method. The survey methods included telephone interviews ( n = 16, 41.0%), face-to-face interviews ( n = 11, 28.2%), questionnaires during the follow-up visit ( n = 10, 25.6%), and postal questionnaires ( n = 4, 10.3%).…”

Incidence and Influencing Factors of Anxiety and Depression in Individuals with Acute Ischemic Stroke: A Retrospective Study

“…Anxiety and depression, which are recognized mental disorders that develop after AIS, continue to increase in prevalence. Anxiety and depression occur in approximately 40% of patients with AIS [ 15 ]. In view of this, we examine the incidence of anxiety and depression in individuals with AIS and analyze the influencing factors.…”