The Long-Term Functional Effect of Thrombectomy on Patients with Middle Cerebral Artery Occlusion Who Exhibit Moderate to Severe Disability

Abstract

Background and Objectives: Endovascular thrombectomy (EVT is an emerging gold standard treatment for acute cerebral infarction and may allow functional improvement after subacute cerebral infarction. However, the long-term functional benefits of EVT in patients with moderate to severe disability remain unclear. We investigated the effects of EVT on the activities of daily living (ADL), handicap, gait, and eating in patients with middle cerebral artery (MCA) occlusion who exhibited moderate to severe disability (score of 3–5 on the modified Rankin scale (mRS)) due to stroke, up to six months after onset. Materials and Methods: This retrospective longitudinal case–control study assessed 45 patients with MCA occlusion who exhibited moderate to severe disability (mRS score ≥ 3): 15 underwent EVT and 30 served as controls. Clinical assessments were conducted at two weeks (12–16 days), four weeks (26–30 days), and six months (180–210 days) after stroke onset. Functional assessments comprised the Korean version of the modified Barthel index (MBI), mRS, functional ambulation category (FAC), and dysphagia outcome severity scale (DOSS) to assess disability, handicap, gait, and eating. Results: The MBI, mRS, FAC, and DOSS scores all improved significantly (all p < 0.05) in the EVT group, compared to the controls. Conclusions: EVT has favorable effects on performing routine ADL, the handicap itself, walking, and eating. Therefore, EVT is recommended for patients with acute MCA occlusion, including those with severe disability at the initial assessment.

An exploratory study of longitudinal trajectory of language, swallowing and cognition post endovascular clot retrieval

“…These findings are congruent with Yi et al. (2021) who found that participants with moderate to severe disability at 2 weeks post ECR (mRS 3–5) exhibited moderate swallowing impairment (mean dysphagia outcome severity scale (O'Neil et al., 1999) (DOSS = 3) at 2 weeks, but recovered to mild swallowing impairment by 4 weeks (mean DOSS = 5) and on average were able to consume a regular diet by 6 months. The incidence of swallowing impairment in the current study was lower than Minchell et al.…”

“…In contrast to language and cognitive performance, the incidence of swallowing impairment in the current study was only 24% at initial assessment (i.e., within 7 days of stroke and ECR) and all participants had recovered by the final assessment at 3 months. These findings are congruent with Yi et al (2021) who found that participants with moderate to severe disability at 2 weeks post ECR (mRS 3-5) exhibited moderate swallowing impairment (mean dysphagia outcome severity scale (O'Neil et al, 1999) (DOSS = 3) at 2 weeks, but recovered to mild swallowing impairment by 4 weeks (mean DOSS = 5) and on average were able to consume a regular diet by 6 months. The incidence of swallowing impairment in the current study was lower than Minchell et al (2022) who reported 64% of participants presented with dysphagia post ECR.…”

“…This retrospective study found the incidence of dysphagia was correlated with reperfusion success measured with the thrombolysis in cerebral infarction (TICI) score (Minchell et al., 2022) but provide no longitudinal follow‐up of swallowing or functional outcomes. Another retrospective study demonstrated severity of swallowing impairment at one month post‐endovascular treatment was comparable to the control group when adjusted for stroke severity (Yi et al., 2021).…”