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Ganesh A, Volny O, Kovacova I, Tomek A, Bar M, Pádr R, Cihlar F, Nevsimalova M, Jurak L, Havlicek R, Kovar M, Sevcik P, Rohan V, Fiksa J, Cerník D, Jura R, Vaclavik D, Hill MD, Mikulík R. Utilization, Workflow, and Outcomes of Endovascular Thrombectomy in Patients With vs Without Premorbid Disability in a National Registry. Neurol Clin Pract 2024; 14:e200341. [PMID: 39185095 PMCID: PMC11341008 DOI: 10.1212/cpj.0000000000200341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/17/2024] [Indexed: 08/27/2024]
Abstract
Background and Objectives Given the paucity of high-quality safety/efficacy data on acute stroke therapies in patients with premorbid disability, they risk being routinely excluded from such therapies. We examined utilization of endovascular thrombectomy (EVT), associated workflow, and poststroke outcomes among patients with vs without premorbid disability. Methods We used national registry data on thrombolysis/EVT for the Czech Republic from 1 January 2016 to 31 December 2020. Premorbid disability was defined as prestroke modified Rankin Scale score (mRS) ≥3. We compared proportions of patients with vs without premorbid disability who received EVT and examined workflow times. We compared ΔmRS-change in mRS from prestroke to 3 months-in patients with vs without premorbid disability, in addition to intracerebral hemorrhage (ICH), mortality, and discharge NIHSS (National Institutes of Health Stroke Scale score), adjusting for age, sex, baseline NIHSS, and comorbidities, and verified using propensity score weighting (PSW) and matching for differences in treatment assignment. We stratified by age group (<65, 65-74, 75-84, ≥85 years) to explore outcome heterogeneity with vs without premorbid disability. Results Among 22,405 patients with ischemic stroke who received thrombolysis/EVT/both, 1,712 (7.6%) had prestroke mRS ≥ 3. Patients with prestroke disability were less likely to receive EVT vs those without (10.1% vs 20.7%, aOR: 0.30, 95% CI 0.24-0.36). When treated, they had longer door-to-arterial puncture times (median: 75 minutes, IQR: 58-100 vs 54, IQR: 27-77, adjusted difference: 12.5, 95% CI 2.68-22.3). Patients with prestroke disability receiving thrombolysis/EVT/both had worse ΔmRS (adjusted rate ratio, aIRR on PSW: 1.57, 95% CI 1.43-1.72), rates of 3-month mRS 5-6, discharge NIHSS, and mortality (aOR-PSW [mortality]: 2.54, 95% CI 1.92-3.34), while ICH did not significantly differ. 32.1% of patients with prestroke disability receiving thrombolysis/EVT/both successfully returned to prestroke state, but this proportion ranged from 19.6% for those older than 85 years to 66.0% for those younger than 65 years. Regardless of premorbid disability, EVT was associated with better outcomes including lower ΔmRS (aIRR-PSW: 0.87, 95% CI 0.83-0.91) and mortality, with no interaction of treatment effect by premorbid disability status (e.g., mortality pinteraction = 0.73). EVT recipients with premorbid disability did not differ significantly for several outcomes including ΔmRS (aIRR: 0.99, 95% CI 0.84-1.17) but were more likely to have 3-month mRS 5-6 (70.1% vs 39.5% without premorbid disability, aOR: 1.85, 95% CI 1.12-3.04). Discussion Patients with premorbid disability were less likely to receive EVT, had slower treatment times, and had worse outcomes compared with patients without premorbid disability. However, regardless of premorbid disability, patients fared better with EVT vs medical management and one-third with prestroke disability returned to their prestroke status.
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Affiliation(s)
- Aravind Ganesh
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| | - Ondrej Volny
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| | - Ingrid Kovacova
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| | - Aleš Tomek
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| | - Michal Bar
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| | - Radek Pádr
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| | - Filip Cihlar
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| | - Miroslava Nevsimalova
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| | - Lubomir Jurak
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| | - Roman Havlicek
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| | - Martin Kovar
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| | - Petr Sevcik
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| | - Vladimír Rohan
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| | - Jan Fiksa
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| | - David Cerník
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| | - Rene Jura
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| | - Daniel Vaclavik
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| | - Michael D Hill
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| | - Robert Mikulík
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
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Tanaka K, Yamagami H, Qureshi MM, Uchida K, Siegler JE, Nogueira RG, Yoshimura S, Sakai N, Martinez-Majander N, Nagel S, Demeestere J, Puetz V, Haussen DC, Abdalkader M, Olive-Gadea M, Mohammaden MH, Marto JP, Dusart A, Winzer S, Tomppo L, Caparros F, Henon H, Bellante F, Ramos JN, Ortega-Gutierrez S, Sheth SA, Nannoni S, Kaesmacher J, Vandewalle L, Salazar-Marioni S, Farooqui M, Virtanen P, Ventura R, Zaidi S, Castonguay AC, Puri AS, Farzin B, Masoud HE, Klein P, Jesser J, Requena M, Dobrocky T, Kaiser DP, Peltola E, Strambo D, Möhlenbruch MA, Lin E, Ringleb PA, Zaidat OO, Cordonnier C, Roy D, Lemmens R, Ribo M, Strbian D, Fischer U, Michel P, Raymond J, Nguyen TN. Endovascular Therapy in the Extended Time Window for Large Vessel Occlusion in Patients With Pre-Stroke Disability. J Stroke 2024; 26:269-279. [PMID: 38836274 PMCID: PMC11164586 DOI: 10.5853/jos.2023.04259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/24/2024] [Accepted: 02/13/2024] [Indexed: 06/06/2024] Open
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 pre-stroke 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.
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Affiliation(s)
- Kanta Tanaka
- Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan
- Stroke Center, Kindai University Hospital, Osakasayama, Japan
| | - Hiroshi Yamagami
- Division of Stroke Prevention and Treatment, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Muhammad M. Qureshi
- Department of Radiology, Radiation Oncology, Boston Medical Center, Boston, MA, USA
| | - Kazutaka Uchida
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
| | - James E. Siegler
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Raul G. Nogueira
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical General Hospital, Kobe, Japan
| | | | - Simon Nagel
- Department of Neurology, Klinikum Ludwigshafen, Heidelberg University Hospital, Ludwigshafen, Germany
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jelle Demeestere
- Department of Neurology, Leuven University Hospital, Leuven, Belgium
| | - Volker Puetz
- Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Dresden Neurovascular Center, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Diogo C. Haussen
- Department of Neurology, Grady Memorial Hospital, Atlanta, GA, USA
| | - Mohamad Abdalkader
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | | | | | - João Pedro Marto
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Anne Dusart
- Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium
| | - Simon Winzer
- Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Liisa Tomppo
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Francois Caparros
- Department of Neurology, Centre Hospitalier Universitaire de Lille, University of Lille, Lille, France
| | - Hilde Henon
- Department of Neurology, Centre Hospitalier Universitaire de Lille, University of Lille, Lille, France
| | - Flavio Bellante
- Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium
| | - João Nuno Ramos
- Department of Neuroradiology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | | | - Sunil A. Sheth
- Department of Neurology, UTHealth Houston, Houston, TX, USA
| | - Stefania Nannoni
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, University of Bern, Bern, Switzerland
| | | | | | | | - Pekka Virtanen
- Department of Radiology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Rita Ventura
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Syed Zaidi
- Department of Neurology, University of Toledo, Toledo, OH, USA
| | | | - Ajit S. Puri
- Division of Interventional Neuroradiology, University of Massachusetts Memorial Medical Center, Worcester, MA, USA
| | - Behzad Farzin
- Department of Radiology, Centre Hospitalier de l’Universite de Montreal, Montreal, Canada
| | - Hesham E. Masoud
- Department of Neurology, State University of New York, Upstate Medical University, Syracuse, NY, USA
| | - Piers Klein
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jessica Jesser
- Department of Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Manuel Requena
- Department of Neurology, Hospital Vall d’Hebron, Barcelona, Spain
| | - Tomas Dobrocky
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Daniel P.O. Kaiser
- Department of Diagnostic and Interventional Neuroradiology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Erno Peltola
- Department of Radiology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Davide Strambo
- Department of Neurology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Eugene Lin
- Neuroscience and Stroke Program, Bon Secours Mercy Health St. Vincent Hospital, Toledo, OH, USA
| | - Peter A. Ringleb
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Osama O. Zaidat
- Neuroscience and Stroke Program, Bon Secours Mercy Health St. Vincent Hospital, Toledo, OH, USA
| | - Charlotte Cordonnier
- Department of Neurology, Centre Hospitalier Universitaire de Lille, University of Lille, Lille, France
| | - Daniel Roy
- Department of Radiology, Centre Hospitalier de l’Universite de Montreal, Montreal, Canada
| | - Robin Lemmens
- Department of Neurology, Leuven University Hospital, Leuven, Belgium
| | - Marc Ribo
- Department of Neurology, Hospital Vall d’Hebron, Barcelona, Spain
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Urs Fischer
- Department of Neurology, University Hospital Basel, Switzerland
- Department of Neurology, University Hospital Bern, Switzerland
| | - Patrik Michel
- Department of Neurology, Lausanne University Hospital, Lausanne, Switzerland
| | - Jean Raymond
- Department of Radiology, Centre Hospitalier de l’Universite de Montreal, Montreal, Canada
| | - Thanh N. Nguyen
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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