Jan Gralla1, Hakan Sarikaya2, Lisa Oesch3, Marcel Arnold3, Corrado Bernasconi3, Johannes Kaesmacher1,4, Urs Fischer3, Pascal J Mosimann1, Simon Jung3, Thomas Meinel3, Martina Goeldlin3,1, Mirjam Heldner3, Bastian Volbers3,5. 1. Department of Diagnostic and Interventional Neuroradiology, Bern University Hospital, Freiburgstrasse 10, 3010, Bern, Switzerland. 2. Department of Neurology, Bern University Hospital, Freiburgstrasse 10, 3010, Bern, Switzerland. hakan.sarikaya@insel.ch. 3. Department of Neurology, Bern University Hospital, Freiburgstrasse 10, 3010, Bern, Switzerland. 4. Department of Diagnostic, Interventional and Pediatric Radiology, Bern University Hospital, Freiburgstrasse 10, 3010, Bern, Switzerland. 5. Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany.
Abstract
BACKGROUND AND PURPOSE: Current demographic changes indicate that more people will be care-dependent due to increasing life expectancy. Little is known about impact of preexisting dependency on stroke outcome after endovascular treatment (EVT). METHODS: We compared prospectively collected baseline and outcome data of previously dependent vs. independent stroke patients (prestroke modified Rankin Scale score of 3-5 vs. 0-2) treated with EVT. Outcome measures were favorable 3-month outcome (mRS ≤ 3 for previously dependent and mRS ≤ 2 for independent patients, respectively), death and symptomatic intracranial hemorrhage (sICH). RESULTS: Among 1247 patients, 84 (6.7%) were dependent before stroke. They were older (81 vs. 72 years of age), more often female (61.9% vs. 46%), had a higher stroke severity at baseline (NIHSS 18 vs. 15 points), more often history of previous stroke (32.9% vs. 9.1%) and more vascular risk factors than independent patients. Favorable outcome and mortality were to the disadvantage of independent patients (26.2% vs. 44.4% and 46.4% vs. 25.5%, respectively), whereas sICH was comparable in both cohorts (4.9% vs. 5%). However, preexisting dependency was not associated with clinical outcome and mortality after adjusting for outcome predictors (OR 1.076, 95% CI 0.612-1.891; p = 0.799 and OR 1.267, 95% CI 0.758-2.119; p = 0.367, respectively). CONCLUSION: Our study underscores the need for careful selection of care-dependent stroke patients when considering EVT, given a less favorable outcome observed in this cohort. Nonetheless, EVT should not systematically be withheld in patients with preexisting disability, since prior dependency does not significantly influence outcome.
BACKGROUND AND PURPOSE: Current demographic changes indicate that more people will be care-dependent due to increasing life expectancy. Little is known about impact of preexisting dependency on stroke outcome after endovascular treatment (EVT). METHODS: We compared prospectively collected baseline and outcome data of previously dependent vs. independent strokepatients (prestroke modified Rankin Scale score of 3-5 vs. 0-2) treated with EVT. Outcome measures were favorable 3-month outcome (mRS ≤ 3 for previously dependent and mRS ≤ 2 for independent patients, respectively), death and symptomatic intracranial hemorrhage (sICH). RESULTS: Among 1247 patients, 84 (6.7%) were dependent before stroke. They were older (81 vs. 72 years of age), more often female (61.9% vs. 46%), had a higher stroke severity at baseline (NIHSS 18 vs. 15 points), more often history of previous stroke (32.9% vs. 9.1%) and more vascular risk factors than independent patients. Favorable outcome and mortality were to the disadvantage of independent patients (26.2% vs. 44.4% and 46.4% vs. 25.5%, respectively), whereas sICH was comparable in both cohorts (4.9% vs. 5%). However, preexisting dependency was not associated with clinical outcome and mortality after adjusting for outcome predictors (OR 1.076, 95% CI 0.612-1.891; p = 0.799 and OR 1.267, 95% CI 0.758-2.119; p = 0.367, respectively). CONCLUSION: Our study underscores the need for careful selection of care-dependent strokepatients when considering EVT, given a less favorable outcome observed in this cohort. Nonetheless, EVT should not systematically be withheld in patients with preexisting disability, since prior dependency does not significantly influence outcome.
Authors: Johannes Kaesmacher; Mirjam Kaesmacher; Christian Maegerlein; Claus Zimmer; Alexandra S Gersing; Silke Wunderlich; Benjamin Friedrich; Tobias Boeckh-Behrens; Justus F Kleine Journal: Cerebrovasc Dis Date: 2017-03-25 Impact factor: 2.762
Authors: William J Powers; Alejandro A Rabinstein; Teri Ackerson; Opeolu M Adeoye; Nicholas C Bambakidis; Kyra Becker; José Biller; Michael Brown; Bart M Demaerschalk; Brian Hoh; Edward C Jauch; Chelsea S Kidwell; Thabele M Leslie-Mazwi; Bruce Ovbiagele; Phillip A Scott; Kevin N Sheth; Andrew M Southerland; Deborah V Summers; David L Tirschwell Journal: Stroke Date: 2018-01-24 Impact factor: 7.914
Authors: Jeffrey L Saver; Mayank Goyal; Alain Bonafe; Hans-Christoph Diener; Elad I Levy; Vitor M Pereira; Gregory W Albers; Christophe Cognard; David J Cohen; Werner Hacke; Olav Jansen; Tudor G Jovin; Heinrich P Mattle; Raul G Nogueira; Adnan H Siddiqui; Dileep R Yavagal; Blaise W Baxter; Thomas G Devlin; Demetrius K Lopes; Vivek K Reddy; Richard du Mesnil de Rochemont; Oliver C Singer; Reza Jahan Journal: N Engl J Med Date: 2015-04-17 Impact factor: 91.245
Authors: Robert-Jan B Goldhoorn; Merel Verhagen; Diederik W J Dippel; Aad van der Lugt; Hester F Lingsma; Yvo B W E M Roos; Charles B L M Majoie; Jan Albert Vos; Jelis Boiten; Wim H van Zwam; Robert J van Oostenbrugge; Ido van den Wijngaard Journal: Stroke Date: 2018-10 Impact factor: 7.914
Authors: Susanne Schnitzer; Stefan Blüher; Andrea Teti; Elke Schaeffner; Natalie Ebert; Peter Martus; Ralf Suhr; Adelheid Kuhlmey Journal: J Aging Health Date: 2019-01-18
Authors: Valery L Feigin; Grant Nguyen; Kelly Cercy; Catherine O Johnson; Tahiya Alam; Priyakumari G Parmar; Amanuel A Abajobir; Kalkidan H Abate; Foad Abd-Allah; Ayenew N Abejie; Gebre Y Abyu; Zanfina Ademi; Gina Agarwal; Muktar B Ahmed; Rufus O Akinyemi; Rajaa Al-Raddadi; Leopold N Aminde; Catherine Amlie-Lefond; Hossein Ansari; Hamid Asayesh; Solomon W Asgedom; Tesfay M Atey; Henok T Ayele; Maciej Banach; Amitava Banerjee; Aleksandra Barac; Suzanne L Barker-Collo; Till Bärnighausen; Lars Barregard; Sanjay Basu; Neeraj Bedi; Masoud Behzadifar; Yannick Béjot; Derrick A Bennett; Isabela M Bensenor; Derbew F Berhe; Dube J Boneya; Michael Brainin; Ismael R Campos-Nonato; Valeria Caso; Carlos A Castañeda-Orjuela; Jacquelin C Rivas; Ferrán Catalá-López; Hanne Christensen; Michael H Criqui; Albertino Damasceno; Lalit Dandona; Rakhi Dandona; Kairat Davletov; Barbora de Courten; Gabrielle deVeber; Klara Dokova; Dumessa Edessa; Matthias Endres; Emerito J A Faraon; Maryam S Farvid; Florian Fischer; Kyle Foreman; Mohammad H Forouzanfar; Seana L Gall; Tsegaye T Gebrehiwot; Johanna M Geleijnse; Richard F Gillum; Maurice Giroud; Alessandra C Goulart; Rahul Gupta; Rajeev Gupta; Vladimir Hachinski; Randah R Hamadeh; Graeme J Hankey; Habtamu A Hareri; Rasmus Havmoeller; Simon I Hay; Mohamed I Hegazy; Desalegn T Hibstu; Spencer L James; Panniyammakal Jeemon; Denny John; Jost B Jonas; Jacek Jóźwiak; Rizwan Kalani; Amit Kandel; Amir Kasaeian; Andre P Kengne; Yousef S Khader; Abdur R Khan; Young-Ho Khang; Jagdish Khubchandani; Daniel Kim; Yun J Kim; Mika Kivimaki; Yoshihiro Kokubo; Dhaval Kolte; Jacek A Kopec; Soewarta Kosen; Michael Kravchenko; Rita Krishnamurthi; G Anil Kumar; Alessandra Lafranconi; Pablo M Lavados; Yirga Legesse; Yongmei Li; Xiaofeng Liang; Warren D Lo; Stefan Lorkowski; Paulo A Lotufo; Clement T Loy; Mark T Mackay; Hassan Magdy Abd El Razek; Mahdi Mahdavi; Azeem Majeed; Reza Malekzadeh; Deborah C Malta; Abdullah A Mamun; Lorenzo G Mantovani; Sheila C O Martins; Kedar K Mate; Mohsen Mazidi; Suresh Mehata; Toni Meier; Yohannes A Melaku; Walter Mendoza; George A Mensah; Atte Meretoja; Haftay B Mezgebe; Tomasz Miazgowski; Ted R Miller; Norlinah M Ibrahim; Shafiu Mohammed; Ali H Mokdad; Mahmood Moosazadeh; Andrew E Moran; Kamarul I Musa; Ruxandra I Negoi; Minh Nguyen; Quyen L Nguyen; Trang H Nguyen; Tung T Tran; Thanh T Nguyen; Dina Nur Anggraini Ningrum; Bo Norrving; Jean J Noubiap; Martin J O’Donnell; Andrew T Olagunju; Oyere K Onuma; Mayowa O Owolabi; Mahboubeh Parsaeian; George C Patton; Michael Piradov; Martin A Pletcher; Farshad Pourmalek; V Prakash; Mostafa Qorbani; Mahfuzar Rahman; Muhammad A Rahman; Rajesh K Rai; Annemarei Ranta; David Rawaf; Salman Rawaf; Andre MN Renzaho; Stephen R Robinson; Ramesh Sahathevan; Amirhossein Sahebkar; Joshua A Salomon; Paola Santalucia; Itamar S Santos; Benn Sartorius; Aletta E Schutte; Sadaf G Sepanlou; Azadeh Shafieesabet; Masood A Shaikh; Morteza Shamsizadeh; Kevin N Sheth; Mekonnen Sisay; Min-Jeong Shin; Ivy Shiue; Diego A S Silva; Eugene Sobngwi; Michael Soljak; Reed J D Sorensen; Luciano A Sposato; Saverio Stranges; Rizwan A Suliankatchi; Rafael Tabarés-Seisdedos; David Tanne; Cuong Tat Nguyen; J S Thakur; Amanda G Thrift; David L Tirschwell; Roman Topor-Madry; Bach X Tran; Luong T Nguyen; Thomas Truelsen; Nikolaos Tsilimparis; Stefanos Tyrovolas; Kingsley N Ukwaja; Olalekan A Uthman; Yuri Varakin; Tommi Vasankari; Narayanaswamy Venketasubramanian; Vasiliy V Vlassov; Wenzhi Wang; Andrea Werdecker; Charles D A Wolfe; Gelin Xu; Yuichiro Yano; Naohiro Yonemoto; Chuanhua Yu; Zoubida Zaidi; Maysaa El Sayed Zaki; Maigeng Zhou; Boback Ziaeian; Ben Zipkin; Theo Vos; Mohsen Naghavi; Christopher J L Murray; Gregory A Roth Journal: N Engl J Med Date: 2018-12-20 Impact factor: 91.245