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Observational Study
. 2021 Aug 3;10(15):e020783.
doi: 10.1161/JAHA.121.020783. Epub 2021 Jul 21.

Endovascular Therapy for Acute Ischemic Stroke in Patients With Prestroke Disability

Kanta Tanaka  1 , Hiroshi Yamagami  2 , Takeshi Yoshimoto  1 , Kazutaka Uchida  3 , Takeshi Morimoto  4 , Kazunori Toyoda  5 , Nobuyuki Sakai  6 , Shinichi Yoshimura  3
Affiliations
Observational Study

Endovascular Therapy for Acute Ischemic Stroke in Patients With Prestroke Disability

Kanta Tanaka et al. J Am Heart Assoc. .

Abstract

Background Outcomes after stroke as a result of large-vessel occlusion in patients with prestroke disability were compared between endovascular therapy (EVT) and medical management. Methods and Results Of 2420 patients with acute stroke with large-vessel occlusion in a prospective, multicenter, nationwide registry in Japan, patients with prestroke modified Rankin Scale scores 2 to 4 with occlusion of the internal carotid artery, or M1 of the middle cerebral artery were analyzed. The primary effectiveness outcome was the favorable outcome, defined as return to at least the prestroke modified Rankin Scale score at 3 months. Safety outcomes included symptomatic intracranial hemorrhage. A total of 339 patients (237 women; median 85 [interquartile range (IQR), 79-89] years of age; median prestroke modified Rankin Scale score of 3 [IQR, 2-4]) were analyzed. EVT was performed in 175 patients (51.6%; mechanical thrombectomy, n=139). The EVT group was younger (p<0.01) and had lower prestroke modified Rankin Scale scores (p<0.01) than the medical management group. The favorable outcome was seen in 28.0% of the EVT group and in 10.9% of the medical management group (p<0.01). EVT was associated with the favorable outcome (adjusted odds ratio, 3.01; 95% CI, 1.55-5.85; mixed effects multivariable model with inverse probability of treatment weighting). Symptomatic intracranial hemorrhage rates were similar between the EVT (4.0%) and medical management (4.3%) groups (p=1.00). Conclusions Patients who underwent EVT showed better functional outcomes than those with medical management. Given proper patient selection, withholding EVT solely on the basis of prestroke disability might not offer the best chance of favorable outcome. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02419794.

Keywords: disability; endovascular therapy; outcome; stroke; thrombectomy.

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Conflict of interest statement

Dr Tanaka reports lecturer’s fees from Johnson and Johnson, Medico’s Hirata, and Stryker. Dr Yamagami reports research grants from Bristol‐Myers Squibb; lecturer’s fees from Stryker, Terumo, Medtronic, Medico’s Hirata, Johnson and Johnson, Bayer, Daiichi‐Sankyo, Bristol‐Myers Squibb, Boehringer Ingelheim, Takeda, and Otsuka Pharmaceutical; and membership of the advisory boards for Daiichi‐Sankyo. Dr Morimoto reports lecturer’s fees from Bristol‐Myers Squibb, Daiichi Sankyo, Japan Lifeline, Kowa, Kyocera, Novartis, and Toray; manuscript fees from Bristol‐Myers Squibb and Kowa; and membership of the advisory board for Sanofi. Dr Toyoda reports lecturer’s fees from Daiichi Sankyo, Boehringer Ingelheim, Bayer, Takeda, and Bristol‐Myers Squibb outside of the submitted study. Dr Sakai reports a research grant from Terumo; lecturer’s fees from Jimro, Johnson and Johnson, Medico’s Hirata, Medtronic, and Stryker; and membership of the advisory boards for Jimro and Medtronic. Dr Yoshimura reports research grants from Medtronic, Medico’s Hirata, and Terumo and lecturer’s fees from Stryker and Medtronic. The remaining authors have no disclosures to report.

Figures

Figure 1
Figure 1. Study flow chart.
ACA indicates anterior cerebral artery; EVT, endovascular therapy; ICA, internal carotid artery; LKW, last known well; LVO, large‐vessel occlusion; mRS, modified Rankin Scale; and RESCUE, Recovery by Endovascular Salvage for Cerebral Ultra‐Acute Embolism.
Figure 2
Figure 2. Intergroup absolute standardized differences before and after IPTW.
ASPECTS indicates Alberta Stroke Program Early Computed Tomographic Score; BP, blood pressure; ICA, internal carotid artery; IPTW, inverse probability of treatment weighting; IVT, intravenous thrombolysis; LKW, last known well; mRS, modified Rankin Scale; and NIHSS, National Institutes of Health Stroke Scale.
Figure 3
Figure 3. Distribution of prestroke modified Rankin Scale scores and modified Rankin Scale scores at 3 months.
See this image and copyright information in PMC

References

    1. Berkhemer OA, Fransen PSS, Beumer D, van den Berg LA , Lingsma HF, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJH, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372:11–20. DOI: 10.1056/NEJMoa1411587. - DOI - PubMed
    1. Campbell BCV, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, Yan B, Dowling RJ, Parsons MW, Oxley TJ, et al. Endovascular therapy for ischemic stroke with perfusion‐imaging selection. N Engl J Med. 2015;372:1009–1018. DOI: 10.1056/NEJMoa1414792. - DOI - PubMed
    1. Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, Roy D, Jovin TG, Willinsky RA, Sapkota BL, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372:1019–1030. DOI: 10.1056/NEJMoa1414905. - DOI - PubMed
    1. Jovin TG, Chamorro A, Cobo E, de Miquel MA , Molina CA, Rovira A, San Román L, Serena J, Abilleira S, Ribó M, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372:2296–2306. DOI: 10.1056/NEJMoa1503780. - DOI - PubMed
    1. Saver JL, Goyal M, Bonafe A, Diener H‐C, Levy EI, Pereira VM, Albers GW, Cognard C, Cohen DJ, Hacke W, et al. Stent‐retriever thrombectomy after intravenous t‐PA vs. t‐PA alone in stroke. N Engl J Med. 2015;372:2285–2295. DOI: 10.1056/NEJMoa1415061. - DOI - PubMed

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