Endovascular Therapy in the Extended Time Window for Large Vessel Occlusion in Patients With Pre-Stroke Disability
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Background and Purpose We compared the outcomes of endovascular therapy (EVT) in an extended time window in patients with large-vessel occlusion (LVO) between patients with and without prestroke disability. Methods In this prespecified analysis of the multinational CT for Late Endovascular Reperfusion study (66 participating sites, 10 countries between 2014 and 2022), we analyzed data from patients with acute ischemic stroke with a pre-stroke modified Rankin Scale (mRS) score of 0–4 and LVO who underwent EVT 6–24 hours from the time last seen well. The primary outcome was the composite of functional independence (FI; mRS score 0–2) or return to the pre-stroke mRS score (return of Rankin, RoR) at 90 days. Outcomes were compared between patients with pre-stroke disability (pre-stroke mRS score 2–4) and those without (mRS score 0–1). Results A total of 2,231 patients (median age, 72 years; median National Institutes of Health Stroke Scale score, 16) were included in the present analysis. Of these, 564 (25%) had pre-stroke disability. The primary outcome (FI or RoR) was observed in 30.7% of patients with pre-stroke disability (FI, 16.5%; RoR, 30.7%) compared to 44.1% of patients without (FI, 44.1%; RoR, 13.0%) (P<0.001). In multivariable logistic regression analysis with inverse probability of treatment weighting, pre-stroke disability was not associated with significantly lower odds of achieving FI or RoR (adjusted odds ratio 0.73, 95% confidence interval 0.43–1.25). Symptomatic intracranial hemorrhage occurred in 6.3% of both groups (P=0.995). Conclusion A considerable proportion of patients with late-presenting LVO and pre-stroke disability regained pre-stroke mRS scores after EVT. EVT may be appropriate for patients with pre-stroke disability presenting in the extended time window.
Abstract
Background and Purpose We compared the outcomes of endovascular therapy (EVT) in an extended time window in patients with large-vessel occlusion (LVO) between patients with and without prestroke disability. Methods In this prespecified analysis of the multinational CT for Late Endovascular Reperfusion study (66 participating sites, 10 countries between 2014 and 2022), we analyzed data from patients with acute ischemic stroke with a pre-stroke modified Rankin Scale (mRS) score of 0–4 and LVO who underwent EVT 6–24 hours from the time last seen well. The primary outcome was the composite of functional independence (FI; mRS score 0–2) or return to the pre-stroke mRS score (return of Rankin, RoR) at 90 days. Outcomes were compared between patients with pre-stroke disability (pre-stroke mRS score 2–4) and those without (mRS score 0–1). Results A total of 2,231 patients (median age, 72 years; median National Institutes of Health Stroke Scale score, 16) were included in the present analysis. Of these, 564 (25%) had pre-stroke disability. The primary outcome (FI or RoR) was observed in 30.7% of patients with pre-stroke disability (FI, 16.5%; RoR, 30.7%) compared to 44.1% of patients without (FI, 44.1%; RoR, 13.0%) (P<0.001). In multivariable logistic regression analysis with inverse probability of treatment weighting, pre-stroke disability was not associated with significantly lower odds of achieving FI or RoR (adjusted odds ratio 0.73, 95% confidence interval 0.43–1.25). Symptomatic intracranial hemorrhage occurred in 6.3% of both groups (P=0.995). Conclusion A considerable proportion of patients with late-presenting LVO and pre-stroke disability regained pre-stroke mRS scores after EVT. EVT may be appropriate for patients with pre-stroke disability presenting in the extended time window.
참고문헌 (38)
- Yamagami H, "Guidelines for mechanical thrombectomy in Japan, the fourth edition, March 2020: a guideline from the Japan Stroke Society, the Japan Neurosurgical Society, and the Japanese Society for Neuroendovascular Therapy", Neurol Med Chir(Tokyo), 61, pp.163~192 (2021)
- Powers WJ, "Guidelines for the early management of patients with acute ischemic stroke : 2019 update to the 2018 guidelines for the early management of acute ischemic stroke : a guideline for healthcare professionals from the American Heart Association", American Stroke Association, 2019, pp.50, e344~e418
- Ganesh A, "Long-term consequences of worsened poststroke status in patients with premorbid disability", Stroke, 49, pp.2430~2436 (2018)
- Goyal M, "Endovascular thrombectomy after largevessel ischaemic stroke : a meta-analysis of individual patient data from five randomised trials", Lancet, 387, pp.1723~1731 (2016)
- Nogueira RG, "Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct", N Engl J Med, 378, pp.11~21 (2018)
- Yoshimura S, "Endovascular therapy for acute stroke with a large ischemic region", N Engl J Med, 386, pp.1303~1313 (2022)
- Sarraj A, "Trial of endovascular thrombectomy for large ischemic strokes", N Engl J Med, 388, pp.1259~1271 (2023)
- Huo X, "Trial of endovascular therapy for acute ischemic stroke with large infarct", N Engl J Med, 388, pp.1272~1283 (2023)
- Nguyen TN, "The problem of restrictive thrombectomy trial eligibility criteria", Stroke, 53, pp.2988~2990 (2022)
- Albers GW, "Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging", N Engl J Med, 378, pp.708~718 (2018)
- Young MJ, "Disabling stroke in persons already with a disability : ethical dimensions and directives", Neurology, 94, pp.306~310 (2020)
- Ganesh A, "Endovascular treatment and thrombolysis for acute ischemic stroke in patients with premorbid disability or dementia : a scientific statement from the American Heart Association", American Stroke Association, 2022, pp.53, e204~e217
- Goldhoorn RB, "Safety and outcome of endovascular treatment in prestroke-dependent patients", Stroke, 49, pp.2406~2414 (2018)
- Slawski DE, "Mechanical thrombectomy in elderly stroke patients with mild-to-moderate baseline disability", Interv Neurol, 7, pp.246~255 (2018)
- Salwi S, "Mechanical thrombectomy in patients with ischemic stroke with prestroke disability", Stroke, 51, pp.1539~1545 (2020)
- Larsson A, "Do patients with large vessel occlusion ischemic stroke harboring prestroke disability benefit from thrombectomy?", J Neurol, 267, pp.2667~2674 (2020)
- de Havenon A, "Prestroke disability and outcome after thrombectomy for emergent anterior circulation large vessel occlusion stroke", Neurology, 97, pp.e1914~e1919 (2021)
- Seker F, "Clinical outcome after thrombectomy in patients with stroke with premorbid modified Rankin scale scores of 3 and 4 : a cohort study with 136 patients", AJNR Am J Neuroradiol, 40, pp.283~286 (2019)
- Tanaka K, "Endovascular therapy for acute ischemic stroke in patients with prestroke disability", J Am Heart Assoc, 10, pp.e020783~ (2021)
- Siegler JE, "Endovascular vs medical management for late anterior large vessel occlusion with prestroke disability : analysis of CLEAR and RESCUE-Japan", Neurology, 100, pp.e751~e763 (2023)
- Yoshimura S, "Endovascular therapy in ischemic stroke with acute large-vessel occlusion : recovery by endovascular salvage for cerebral ultra-acute embolism Japan registry 2", J Am Heart Assoc, 7, pp.e008796~ (2018)
- Nguyen TN, "Noncontrast computed tomography vs computed tomography perfusion or magnetic resonance imaging selection in late presentation of stroke with large-vessel occlusion", JAMA Neurol, 79, pp.22~31 (2022)
- Seker F, "Reperfusion without functional independence in late presentation of stroke with large vessel occlusion", Stroke, 53, pp.3594~3604 (2022)
- von Elm E, "The strengthening the reporting of observational studies in epidemiology(STROBE)statement : guidelines for reporting observational studies", Lancet, 370, pp.1453~1457 (2007)
- Demeestere J, "Outcomes of bridging intravenous thrombolysis versus endovascular therapy alone in late-window acute ischemic stroke", Stroke (2024)[DOI]
- Nguyen TN, "Noncontrast CT selected thrombectomy vs medical management for late-window anterior large vessel occlusion", Neurology, 102, pp.e209324~ (2024)
- Mujanovic A, "Safety and clinical outcomes of endovascular therapy versus medical management in late presentation of large ischemic stroke", Eur Stroke J (2024)[DOI]
- Wilson JT, "Improving the assessment of outcomes in stroke : use of a structured interview to assign grades on the modified Rankin scale", Stroke, 33, pp.2243~2246 (2002)
- Hacke W, "Thrombolysis with alteplase 3 to 4. 5 hours after acute ischemic stroke", N Engl J Med, 359, pp.1317~1329 (2008)
- Chaisinanunkul N, "Adopting a patient-centered approach to primary outcome analysis of acute stroke trials using a utilityweighted modified Rankin scale", Stroke, 46, pp.2238~2243 (2015)
- McDonough RV, "Clinical outcome of patients with mild prestroke morbidity following endovascular treatment : a HERMES substudy", J Neurointerv Surg, 15, pp.214~220 (2023)
- Darsaut TE, "Patients may be right : clinical research should be designed in their best medical interest", Neurochirurgie, 69, pp.101391~ (2023)
- Han TS, "Prestroke disability predicts adverse poststroke outcome : a registry-based prospective cohort study of acute stroke", Stroke, 51, pp.594~600 (2020)
- Chen H, "Associations of osteoarthritis with thrombectomy utilization and outcomes for large vessel acute ischemic stroke", Stroke, 54, pp.518~526 (2023)
- Prakapenia A, "Misjudgment of pre-stroke functional status contradicts beneficial outcomes after endovascular therapy for large vessel occlusion", J Neurol, 266, pp.2060~2065 (2019)
- Fearon P, "Prestroke modified Rankin stroke scale has moderate interobserver reliability and validity in an acute stroke setting", Stroke, 43, pp.3184~3188 (2012)
- Quinn TJ, "Barthel index for stroke trials : development, properties, and application", Stroke, 42, pp.1146~1151 (2011)
- Williams LS, "Development of a stroke-specific quality of life scale", Stroke, 30, pp.1362~1369 (1999)