El Grabli Florent1, Casolla Barbara2, Ferrigno Marc1, Kyheng Maeva3, Bala Fouzi4, Della Schiava Lucie1, Cordonnier Charlotte5, Bricout Nicolas4, Henon Hilde1. 1. Univ. Lille, Inserm U1172, CHU Lille, Department of Neurology, Stroke unit, France. 2. Univ. Lille, Inserm U1172, CHU Lille, Department of Neurology, Stroke unit, France. Electronic address: barbara.casolla@gmail.com. 3. Univ. Lille, CHU Lille, ULR 2694 - METRICS évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France.; CHU Lille, Département de Biostatistiques, F-59000 Lille, France. 4. Interventional Neuroradiology, CHU Lille, Lille, France. 5. Univ. Lille, Inserm U1172, CHU Lille, Department of Neurology, Stroke unit, France. Electronic address: https://twitter.com/PrCCordonnier.
Abstract
OBJECTIVES: Pre-stroke dependency (PSD) is associated with poor outcome after stroke. The aim of the study was to evaluate the clinical outcomes and safety of mechanical thrombectomy (MT) in pre-stroke dependent patients compared to pre-stroke independent patients. MATERIAL AND METHODS: We included consecutive patients with anterior circulation acute ischaemic stroke related to large vessel occlusion (AIS-LVO), treated by MT between January 1st 2015 and July 1st 2018 in our single comprehensive stroke center. PSD was defined as a mRS score of 3 to 5 before stroke onset. We studied outcome variables in pre-stroke dependent vs. independent patients, by using logistic regression models. Clinical outcomes included clinical favorable outcome at 3 months (defined as modified Rankin Score 0-2 or equal to pre-stroke mRS score), successful recanalization rates and safety outcomes. RESULTS: Of 922 patients with anterior circulation AIS-LVO, 155 (16.8%) had PSD. Favorable outcome was less often achieved in patients with PSD (25.8% vs. 44.7%, p <0.001); but the difference did not remain significant in multivariable analysis (adjusted OR, 0.70; 95%CI, 0.44 to 1.12). Mortality at 90-days was significantly higher in patients with PSD (49.0% vs. 18.8%, adjusted OR, 2.63; 95%CI, 1.69 to 4.00). Successful recanalization was strongly associated with favorable outcome (adjusted OR, 8.15; 95%CI 4.97 to 13.34). CONCLUSIONS: One out of four patients with PSD had a favorable outcome after MT. Despite higher mortality rates compared to pre-stroke independent patients, PSD alone should not be used alone to deny mechanical thrombectomy.
OBJECTIVES: Pre-stroke dependency (PSD) is associated with poor outcome after stroke. The aim of the study was to evaluate the clinical outcomes and safety of mechanical thrombectomy (MT) in pre-stroke dependent patients compared to pre-stroke independent patients. MATERIAL AND METHODS: We included consecutive patients with anterior circulation acute ischaemic stroke related to large vessel occlusion (AIS-LVO), treated by MT between January 1st 2015 and July 1st 2018 in our single comprehensive stroke center. PSD was defined as a mRS score of 3 to 5 before stroke onset. We studied outcome variables in pre-stroke dependent vs. independent patients, by using logistic regression models. Clinical outcomes included clinical favorable outcome at 3 months (defined as modified Rankin Score 0-2 or equal to pre-stroke mRS score), successful recanalization rates and safety outcomes. RESULTS: Of 922 patients with anterior circulation AIS-LVO, 155 (16.8%) had PSD. Favorable outcome was less often achieved in patients with PSD (25.8% vs. 44.7%, p <0.001); but the difference did not remain significant in multivariable analysis (adjusted OR, 0.70; 95%CI, 0.44 to 1.12). Mortality at 90-days was significantly higher in patients with PSD (49.0% vs. 18.8%, adjusted OR, 2.63; 95%CI, 1.69 to 4.00). Successful recanalization was strongly associated with favorable outcome (adjusted OR, 8.15; 95%CI 4.97 to 13.34). CONCLUSIONS: One out of four patients with PSD had a favorable outcome after MT. Despite higher mortality rates compared to pre-stroke independent patients, PSD alone should not be used alone to deny mechanical thrombectomy.