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Pinho J, Meyer T, Mall B, Maring B, Döpp A, Becker J, Wehner A, Thissen S, Schumann-Werner B, Nikoubashman O, Wiesmann M, Schulz JB, Werner CJ, Reich A. Early flexible endoscopic evaluation of swallowing after mechanical thrombectomy in stroke patients. Ann Clin Transl Neurol 2024; 11:757-767. [PMID: 38217067 DOI: 10.1002/acn3.51998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/02/2023] [Accepted: 01/04/2024] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVE The aims of the study were to (1) characterize the findings of flexible endoscopic evaluation of swallowing (FEES) in stroke patients undergoing mechanical thrombectomy (MT); (2) analyse the screening performance of the Standardized Swallowing Assessment (SSA); and (3) study the impact of FEES-defined dysphagia on 3-month outcomes. METHODS This single-centre study was based on a local registry of consecutive acute ischaemic stroke patients undergoing MT during a 1-year period. Patients received FEES within 5 days of admission regardless of the result of dysphagia screening. We compared baseline demographic and clinical characteristics of patients with and without FEES-defined dysphagia. We collected 3-month modified Rankin Scale (mRS) and individual index values of the European Quality of Life 5 Dimensions (EQ-5D-iv). Using univariable and multivariable regression analyses we predicted 3-month outcomes for presence of dysphagia and for FEES-defined dysphagia severity. RESULTS We included 137 patients with a median age of 74 years, 43.1% were female, median NIHSS was 12 and successful recanalization was achieved in 92.7%. Stroke-associated pneumonia occurred in 8% of patients. FEES-defined dysphagia occurred in 81% of patients. Sensitivity of the SSA as a dysphagia screening was 67%. Presence of dysphagia and increasing severity of dysphagia were independently associated with increasing 3-month mRS score. Increasing dysphagia severity dysphagia was independently associated with lower EQ-5D-iv. INTERPRETATION Early FEES-defined dysphagia occurs in four in every five patients undergoing MT. SSA has a suboptimal dysphagia screening performance. Presence of dysphagia and increasing dysphagia severity predict worse functional outcome and worse health-related quality-of-life.
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Affiliation(s)
- João Pinho
- Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Tareq Meyer
- Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Bettina Mall
- Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Bettina Maring
- Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Annalena Döpp
- Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Johanna Becker
- Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Anneke Wehner
- Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Sara Thissen
- Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Beate Schumann-Werner
- Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany
- Department of Neurology and Geriatrics, Johanniter-Krankenhaus Genthin-Stendal GmbH, Stendal, Germany
- Institute of Cognitive Neurology and Dementia Research, Otto Von Guericke University Magdeburg, Magdeburg, Germany
| | - Omid Nikoubashman
- Department of Diagnostic and Interventional Neuroradiology, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Martin Wiesmann
- Department of Diagnostic and Interventional Neuroradiology, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Jörg B Schulz
- Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany
- JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany
| | - Cornelius J Werner
- Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany
- Department of Neurology and Geriatrics, Johanniter-Krankenhaus Genthin-Stendal GmbH, Stendal, Germany
| | - Arno Reich
- Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany
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