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Joundi RA, Smith EE, Ganesh A, Nogueira RG, McTaggart RA, Demchuk AM, Poppe AY, Rempel JL, Field TS, Dowlatshahi D, Sahlas J, Swartz R, Shah R, Sauvageau E, Puetz V, Silver FL, Campbell B, Chapot R, Tymianski M, Goyal M, Hill MD. Time From Hospital Arrival Until Endovascular Thrombectomy and Patient-Reported Outcomes in Acute Ischemic Stroke. JAMA Neurol 2024; 81:752-761. [PMID: 38829660 PMCID: PMC11148789 DOI: 10.1001/jamaneurol.2024.1562] [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: 01/08/2024] [Accepted: 03/29/2024] [Indexed: 06/05/2024]
Abstract
Importance The time-benefit association of endovascular thrombectomy (EVT) in ischemic stroke with patient-reported outcomes is unknown. Objective To assess the time-dependent association of EVT with self-reported quality of life in patients with acute ischemic stroke. Design, Setting, and Participants Data were used from the Safety and Efficacy of Nerinetide in Subjects Undergoing Endovascular Thrombectomy for Stroke (ESCAPE-NA1) trial, which tested the effect of nerinetide on functional outcomes in patients with large vessel occlusion undergoing EVT and enrolled patients from March 1, 2017, to August 12, 2019. The ESCAPE-NA1 trial was an international randomized clinical trial that recruited patients from 7 countries. Patients with EuroQol 5-dimension 5-level (EQ-5D-5L) index values at 90 days and survivors with complete domain scores were included in the current study. Data were analyzed from July to September 2023. Exposure Hospital arrival to arterial puncture time and other time metrics. Main Outcomes and Measures EQ-5D-5L index scores were calculated at 90 days using country-specific value sets. The association between time from hospital arrival to EVT arterial-access (door-to-puncture) and EQ-5D-5L index score, quality-adjusted life years, and visual analog scale (EQ-VAS) were evaluated using quantile regression, adjusting for age, sex, stroke severity, stroke imaging, wake-up stroke, alteplase, and nerinetide treatment and accounting for clustering by site. Using logistic regression, the association between door-to-puncture time and reporting no or slight symptoms (compared with moderate, severe, or extreme problems) was determined in each domain (mobility, self-care, usual activities, pain or discomfort, and anxiety or depression) or across all domains. Time from stroke onset was also evaluated, and missing data were imputed in sensitivity analyses. Results Among 1105 patients in the ESCAPE-NA1 trial, there were 1043 patients with EQ-5D-5L index values at 90 days, among whom 147 had died and were given a score of 0, and 1039 patients (mean [SD] age, 69.0 [13.7] years; 527 male [50.7%]) in the final analysis as 4 did not receive EVT. There were 896 survivors with complete domain scores at 90 days. There was a strong association between door-to-puncture time and EQ-5D-5L index score (increase of 0.03; 95% CI, 0.02-0.04 per 15 minutes of earlier treatment), quality-adjusted life years (increase of 0.29; 95% CI, 0.08-0.49 per 15 minutes of earlier treatment), and EQ-VAS (increase of 1.65; 95% CI, 0.56-2.72 per 15 minutes of earlier treatment). Each 15 minutes of faster door-to-puncture time was associated with higher probability of no or slight problems in each of 5 domains and all domains concurrently (range from 1.86%; 95% CI, 1.14-2.58 for pain or discomfort to 3.55%; 95% CI, 2.06-5.04 for all domains concurrently). Door-to-puncture time less than 60 minutes was associated higher odds of no or slight problems in each domain, ranging from odds ratios of 1.49 (95% CI, 1.13-1.95) for pain or discomfort to 2.59 (95% CI, 1.83-3.68) for mobility, with numbers needed to treat ranging from 7 to 17. Results were similar after multiple imputation of missing data and attenuated when evaluating time from stroke onset. Conclusions and Relevance Results suggest that faster door-to-puncture EVT time was strongly associated with better health-related quality of life across all domains. These results support the beneficial impact of door-to-treatment speed on patient-reported outcomes and should encourage efforts to improve patient-centered care in acute stroke by optimizing in-hospital processes and workflows.
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Affiliation(s)
- Raed A. Joundi
- Division of Neurology, Department of Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Eric E. Smith
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Aravind Ganesh
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Raul G. Nogueira
- Department of Neurology, UPMC Stroke Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ryan A. McTaggart
- Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Andrew M. Demchuk
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, Alberta, Canada
| | - Alexandre Y. Poppe
- Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada
| | - Jeremy L. Rempel
- Department of Radiology, University of Alberta Hospital, Edmonton, Canada
| | - Thalia S. Field
- Department of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dar Dowlatshahi
- Department of Neurology, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Jim Sahlas
- Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Richard Swartz
- Department of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ruchir Shah
- Department of Neurology, Erlanger Hospital, Chattanooga, Tennessee
| | - Eric Sauvageau
- Lyerly Neurosurgery, Baptist Hospital, Jacksonville, Florida
| | - Volker Puetz
- Department of Neurology, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
- Dresden Neurovascular Center, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Frank L. Silver
- University Health Network, Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Bruce Campbell
- Department of Medicine and Neurology, The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - René Chapot
- Department of Neuroradiology, Alfred Krupp Krankenhaus Essen, Essen, Germany
| | | | - Mayank Goyal
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, Alberta, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, Alberta, Canada
| | - Michael D. Hill
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, Alberta, Canada
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Joundi RA, Hill MD, Stang J, Nicol D, Yu AYX, Kapral MK, King JA, Halabi ML, Smith EE. Association Between Time to Treatment With Endovascular Thrombectomy and Home-Time After Acute Ischemic Stroke. Neurology 2024; 102:e209454. [PMID: 38848515 DOI: 10.1212/wnl.0000000000209454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Home-time is a patient-prioritized stroke outcome that can be derived from administrative data linkages. The effect of faster time-to-treatment with endovascular thrombectomy (EVT) on home-time after acute stroke is unknown. METHODS We used the Quality Improvement and Clinical Research registry to identify a cohort of patients who received EVT for acute ischemic stroke between 2015 and 2022 in Alberta, Canada. We calculated days at home in the first 90 days after stroke. We used ordinal regression across 6 ordered categories of home-time to evaluate the association between onset-to-arterial puncture and higher home-time, adjusting for age, sex, rural residence, NIH Stroke Scale, comorbidities, intravenous thrombolysis, and year of treatment. We used restricted cubic splines to assess the nonlinear relationship between continuous variation in time metrics and higher home-time, and also reported the adjusted odds ratios within time categories. We additionally evaluated door-to-puncture and reperfusion times. Finally, we analyzed home-time with zero-inflated models to determine the minutes of earlier treatment required to gain 1 day of home-time. RESULTS We had 1,885 individuals in our final analytic sample. There was a nonlinear increase in home-time with faster treatment when EVT was within 4 hours of stroke onset or 2 hours of hospital arrival. There was a higher odds of achieving more days at home when onset-to-puncture time was <2 hours (adjusted odds ratio 2.36, 95% CI 1.77-3.16) and 2 to <4 hours (1.37, 95% CI 1.11-1.71) compared with ≥6 hours, and when door-to-puncture time was <1 hour (aOR 2.25, 95% CI 1.74-2.90), 1 to <1.5 hours (aOR 1.89, 95% CI 1.47-2.41), and 1.5 to <2 hours (1.35, 95% CI 1.04-1.76) compared with ≥2 hours. Results were consistent for reperfusion times. For every hour of faster treatment within 6 hours of stroke onset, there was an estimated increase in home-time of 4.7 days, meaning that approximately 1 day of home-time was gained for each 12.8 minutes of faster treatment. DISCUSSION Faster time-to-treatment with EVT for acute stroke was associated with greater home-time, particularly within 4 hours of onset-to-puncture and 2 hours of door-to-puncture time. Within 6 hours of stroke onset, each 13 minutes of faster treatment is associated with a gain of 1 day of home-time.
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Affiliation(s)
- Raed A Joundi
- From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Ontario; Departments of Clinical Neurosciences (M.D.H., E.E.S.) and Community Health Sciences (E.E.S.), Cumming School of Medicine, University of Calgary; Data and Analytics (DnA) (J.S., D.N.) and Cardiovascular Health and Stroke Strategic Clinical Network (M.-L.H.), Alberta Health Services; ICES (A.Y.X.Y., M.K.K.), Toronto; Department of Medicine (Neurology) (A.Y.X.Y.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Ontario; Department of Medicine (A.Y.X.Y.), Division of Neurology, University of Toronto; Department of Medicine (General Internal Medicine) (M.K.K.), University of Toronto-University Health Network, Ontario; Alberta Strategy for Patient Oriented Research Support Unit Data Platform (J.A.K.); and Provincial Research Data Services (J.A.K.), Alberta Health Services, Canada
| | - Michael D Hill
- From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Ontario; Departments of Clinical Neurosciences (M.D.H., E.E.S.) and Community Health Sciences (E.E.S.), Cumming School of Medicine, University of Calgary; Data and Analytics (DnA) (J.S., D.N.) and Cardiovascular Health and Stroke Strategic Clinical Network (M.-L.H.), Alberta Health Services; ICES (A.Y.X.Y., M.K.K.), Toronto; Department of Medicine (Neurology) (A.Y.X.Y.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Ontario; Department of Medicine (A.Y.X.Y.), Division of Neurology, University of Toronto; Department of Medicine (General Internal Medicine) (M.K.K.), University of Toronto-University Health Network, Ontario; Alberta Strategy for Patient Oriented Research Support Unit Data Platform (J.A.K.); and Provincial Research Data Services (J.A.K.), Alberta Health Services, Canada
| | - Jillian Stang
- From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Ontario; Departments of Clinical Neurosciences (M.D.H., E.E.S.) and Community Health Sciences (E.E.S.), Cumming School of Medicine, University of Calgary; Data and Analytics (DnA) (J.S., D.N.) and Cardiovascular Health and Stroke Strategic Clinical Network (M.-L.H.), Alberta Health Services; ICES (A.Y.X.Y., M.K.K.), Toronto; Department of Medicine (Neurology) (A.Y.X.Y.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Ontario; Department of Medicine (A.Y.X.Y.), Division of Neurology, University of Toronto; Department of Medicine (General Internal Medicine) (M.K.K.), University of Toronto-University Health Network, Ontario; Alberta Strategy for Patient Oriented Research Support Unit Data Platform (J.A.K.); and Provincial Research Data Services (J.A.K.), Alberta Health Services, Canada
| | - Dana Nicol
- From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Ontario; Departments of Clinical Neurosciences (M.D.H., E.E.S.) and Community Health Sciences (E.E.S.), Cumming School of Medicine, University of Calgary; Data and Analytics (DnA) (J.S., D.N.) and Cardiovascular Health and Stroke Strategic Clinical Network (M.-L.H.), Alberta Health Services; ICES (A.Y.X.Y., M.K.K.), Toronto; Department of Medicine (Neurology) (A.Y.X.Y.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Ontario; Department of Medicine (A.Y.X.Y.), Division of Neurology, University of Toronto; Department of Medicine (General Internal Medicine) (M.K.K.), University of Toronto-University Health Network, Ontario; Alberta Strategy for Patient Oriented Research Support Unit Data Platform (J.A.K.); and Provincial Research Data Services (J.A.K.), Alberta Health Services, Canada
| | - Amy Ying Xin Yu
- From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Ontario; Departments of Clinical Neurosciences (M.D.H., E.E.S.) and Community Health Sciences (E.E.S.), Cumming School of Medicine, University of Calgary; Data and Analytics (DnA) (J.S., D.N.) and Cardiovascular Health and Stroke Strategic Clinical Network (M.-L.H.), Alberta Health Services; ICES (A.Y.X.Y., M.K.K.), Toronto; Department of Medicine (Neurology) (A.Y.X.Y.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Ontario; Department of Medicine (A.Y.X.Y.), Division of Neurology, University of Toronto; Department of Medicine (General Internal Medicine) (M.K.K.), University of Toronto-University Health Network, Ontario; Alberta Strategy for Patient Oriented Research Support Unit Data Platform (J.A.K.); and Provincial Research Data Services (J.A.K.), Alberta Health Services, Canada
| | - Moira K Kapral
- From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Ontario; Departments of Clinical Neurosciences (M.D.H., E.E.S.) and Community Health Sciences (E.E.S.), Cumming School of Medicine, University of Calgary; Data and Analytics (DnA) (J.S., D.N.) and Cardiovascular Health and Stroke Strategic Clinical Network (M.-L.H.), Alberta Health Services; ICES (A.Y.X.Y., M.K.K.), Toronto; Department of Medicine (Neurology) (A.Y.X.Y.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Ontario; Department of Medicine (A.Y.X.Y.), Division of Neurology, University of Toronto; Department of Medicine (General Internal Medicine) (M.K.K.), University of Toronto-University Health Network, Ontario; Alberta Strategy for Patient Oriented Research Support Unit Data Platform (J.A.K.); and Provincial Research Data Services (J.A.K.), Alberta Health Services, Canada
| | - James A King
- From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Ontario; Departments of Clinical Neurosciences (M.D.H., E.E.S.) and Community Health Sciences (E.E.S.), Cumming School of Medicine, University of Calgary; Data and Analytics (DnA) (J.S., D.N.) and Cardiovascular Health and Stroke Strategic Clinical Network (M.-L.H.), Alberta Health Services; ICES (A.Y.X.Y., M.K.K.), Toronto; Department of Medicine (Neurology) (A.Y.X.Y.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Ontario; Department of Medicine (A.Y.X.Y.), Division of Neurology, University of Toronto; Department of Medicine (General Internal Medicine) (M.K.K.), University of Toronto-University Health Network, Ontario; Alberta Strategy for Patient Oriented Research Support Unit Data Platform (J.A.K.); and Provincial Research Data Services (J.A.K.), Alberta Health Services, Canada
| | - Mary-Lou Halabi
- From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Ontario; Departments of Clinical Neurosciences (M.D.H., E.E.S.) and Community Health Sciences (E.E.S.), Cumming School of Medicine, University of Calgary; Data and Analytics (DnA) (J.S., D.N.) and Cardiovascular Health and Stroke Strategic Clinical Network (M.-L.H.), Alberta Health Services; ICES (A.Y.X.Y., M.K.K.), Toronto; Department of Medicine (Neurology) (A.Y.X.Y.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Ontario; Department of Medicine (A.Y.X.Y.), Division of Neurology, University of Toronto; Department of Medicine (General Internal Medicine) (M.K.K.), University of Toronto-University Health Network, Ontario; Alberta Strategy for Patient Oriented Research Support Unit Data Platform (J.A.K.); and Provincial Research Data Services (J.A.K.), Alberta Health Services, Canada
| | - Eric E Smith
- From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Ontario; Departments of Clinical Neurosciences (M.D.H., E.E.S.) and Community Health Sciences (E.E.S.), Cumming School of Medicine, University of Calgary; Data and Analytics (DnA) (J.S., D.N.) and Cardiovascular Health and Stroke Strategic Clinical Network (M.-L.H.), Alberta Health Services; ICES (A.Y.X.Y., M.K.K.), Toronto; Department of Medicine (Neurology) (A.Y.X.Y.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Ontario; Department of Medicine (A.Y.X.Y.), Division of Neurology, University of Toronto; Department of Medicine (General Internal Medicine) (M.K.K.), University of Toronto-University Health Network, Ontario; Alberta Strategy for Patient Oriented Research Support Unit Data Platform (J.A.K.); and Provincial Research Data Services (J.A.K.), Alberta Health Services, Canada
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Ospel JM, Nguyen TN, Jadhav AP, Psychogios MN, Clarençon F, Yan B, Goyal M. Endovascular Treatment of Medium Vessel Occlusion Stroke. Stroke 2024; 55:769-778. [PMID: 38235587 DOI: 10.1161/strokeaha.123.036942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Approximately one-third of acute ischemic strokes with an identifiable vessel occlusion are caused by medium vessel occlusion (MeVO), that is, nonlarge vessel occlusions that are potentially amenable to endovascular treatment (EVT). Management of patients with MeVO is challenging in many ways: detecting MeVOs can be challenging, particularly for inexperienced physicians, and in busy clinical routine, MeVOs, therefore, remain sometimes undiagnosed. While the clinical course of MeVO stroke with medical management, including intravenous thrombolysis, is by no means, benign, it is more favorable compared with large vessel occlusion. At the same time, EVT complication rates are higher, and thus, the marginal benefit of EVT beyond best medical management is expected to be smaller and more challenging to detect if it were present. Several randomized controlled trials are currently underway to investigate whether and to what degree patients with MeVO may benefit from EVT and will soon provide robust data for evidence-based MeVO EVT decision-making. In this review, we discuss different ways of defining MeVOs, strategies to optimize MeVO detection on imaging, and considerations for EVT decision-making in the setting of MeVO stroke. We discuss the technical challenges related to MeVO EVT and conclude with an overview of currently ongoing MeVO EVT trials.
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Affiliation(s)
- Johanna M Ospel
- Department of Diagnostic Imaging (J.M.O., M.G.), Foothills Medical Centre, University of Calgary, AB, Canada
- Department of Clinical Neurosciences (J.M.O., M.G.), Foothills Medical Centre, University of Calgary, AB, Canada
| | - Thanh N Nguyen
- Department of Neurology and Radiology, Boston Medical Center, Boston University School of Medicine, MA (T.N.N.)
| | - Ashutosh P Jadhav
- Department of Neurology, Barrow Neurological Institute, Phoenix, AZ (A.P.J.)
| | | | - Frédéric Clarençon
- Service de Neuroradiologie, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France (F.C.)
| | - Bernard Yan
- Melbourne Brain Centre, Royal Melbourne Hospital, Parkville, VIC, Australia (B.Y.)
| | - Mayank Goyal
- Department of Diagnostic Imaging (J.M.O., M.G.), Foothills Medical Centre, University of Calgary, AB, Canada
- Department of Clinical Neurosciences (J.M.O., M.G.), Foothills Medical Centre, University of Calgary, AB, Canada
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Beyeler M, Pohle F, Weber L, Mueller M, Kurmann CC, Mujanovic A, Clénin L, Piechowiak EI, Meinel TR, Bücke P, Jung S, Seiffge D, Pilgram-Pastor SM, Dobrocky T, Arnold M, Gralla J, Fischer U, Mordasini P, Kaesmacher J. Long-Term Effect of Mechanical Thrombectomy in Stroke Patients According to Advanced Imaging Characteristics. Clin Neuroradiol 2024; 34:105-114. [PMID: 37642685 PMCID: PMC10881753 DOI: 10.1007/s00062-023-01337-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/13/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE Data on long-term effect of mechanical thrombectomy (MT) in patients with large ischemic cores (≥ 70 ml) are scarce. Our study aimed to assess the long-term outcomes in MT-patients according to baseline advanced imaging parameters. METHODS We performed a single-centre retrospective cohort study of stroke patients receiving MT between January 1, 2010 and December 31, 2018. We assessed baseline imaging to determine core and mismatch volumes and hypoperfusion intensity ratio (with low ratio reflecting good collateral status) using RAPID automated post-processing software. Main outcomes were cross-sectional long-term mortality, functional outcome and quality of life by May 2020. Analysis were stratified by the final reperfusion status. RESULTS In total 519 patients were included of whom 288 (55.5%) have deceased at follow-up (median follow-up time 28 months, interquartile range 1-55). Successful reperfusion was associated with lower long-term mortality in patients with ischemic core volumes ≥ 70 ml (adjusted hazard ratio (aHR) 0.20; 95% confidence interval (95% CI) 0.10-0.44) and ≥ 100 ml (aHR 0.26; 95% CI 0.08-0.87). The effect of successful reperfusion on long-term mortality was significant only in the presence of relevant mismatch (aHR 0.17; 95% CI 0.01-0.44). Increasing reperfusion grade was associated with a higher rate of favorable outcomes (mRS 0-3) also in patients with ischemic core volume ≥ 70 ml (aOR 3.58, 95% CI 1.64-7.83). CONCLUSION Our study demonstrated a sustainable benefit of better reperfusion status in patients with large ischemic core volumes. Our results suggest that patient deselection based on large ischemic cores alone is not advisable.
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Affiliation(s)
- Morin Beyeler
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland.
| | - Fabienne Pohle
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Loris Weber
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Madlaine Mueller
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Christoph C Kurmann
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Adnan Mujanovic
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Leander Clénin
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Eike Immo Piechowiak
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Thomas Raphael Meinel
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Philipp Bücke
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Simon Jung
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - David Seiffge
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Sara M Pilgram-Pastor
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Tomas Dobrocky
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Jan Gralla
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
- Neurology Department, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Pasquale Mordasini
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Johannes Kaesmacher
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland.
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Šaňák D, Gurková E, Štureková L, Šaňáková Š, Zapletalová J, Franc D, Bartoníčková D. Quality of Life in Patients with Excellent 3-Month Clinical Outcome after First-Ever Ischemic Stroke: A Time to Redefine Excellent Outcome? Eur Neurol 2024; 87:1-10. [PMID: 38232714 DOI: 10.1159/000535685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/03/2023] [Indexed: 01/19/2024]
Abstract
INTRODUCTION Ischemic stroke (IS) may have impact on long-term health-related quality of life (HRQoL) even in the patients with good clinical outcome, and tools mostly used for the assessment of outcome may underestimate or not reflect all relevant sequels after IS. We aimed to analyze HRQoL in the patients with excellent outcome after IS. METHODS We analyzed consecutive IS patients enrolled in the prospective FRAILTY study (ClinicalTrials.gov: NCT04839887) with excellent 3-month clinical outcome (score 0-1 in modified Rankin Scale [mRS]). Stroke Impact Scale (SIS) version 3.0 and Hospital Anxiety and Depression Scale (HADS) were used for the HRQoL, anxiety, and depression assessments, and subgroup comparisons were performed according to NIHSS score (0, ≥1), age (50<, ≥50 years), and sex. RESULTS In total, 158 patients (55.7% men, mean age 60.3 ± 13.4 years) were analyzed, and 72.2% of them had score 0 in mRS. The overall lowest median scores were found in the SIS domain "emotion," "strength," and "participation." Patients with NIHSS ≥1 had lower scores in all SIS domains except "emotions" and "mobility." Patients ≥50 years had lower score in "mobility" (p = 0.004) and females in domain of "social participation" (p = 0.044). No differences were found among all subgroups in HADS anxiety and depression. Age, NIHSS score, and depression were found negative predictors for the physical domains of HRQoL. DISCUSSION/CONCLUSIONS Despite excellent 3-month clinical outcome after IS, patients had affected substantially their HRQoL, especially those with NIHSS ≥1. Patients ≥50 years had more affected "mobility" and females "social participation."
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Affiliation(s)
- Daniel Šaňák
- Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, Olomouc, Czechia
| | - Elena Gurková
- Department of Nursing, Faculty of Health Sciences, Palacký University, Olomouc, Czechia
| | - Lenka Štureková
- Department of Nursing, Faculty of Health Sciences, Palacký University, Olomouc, Czechia
| | - Šárka Šaňáková
- Department of Nursing, Faculty of Health Sciences, Palacký University, Olomouc, Czechia
| | - Jana Zapletalová
- Department Medical Biophysics, Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czechia
| | - David Franc
- Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, Olomouc, Czechia
| | - Daniela Bartoníčková
- Department of Nursing, Faculty of Health Sciences, Palacký University, Olomouc, Czechia
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Deb-Chatterji M, Flottmann F, Meyer L, Brekenfeld C, Fiehler J, Gerloff C, Thomalla G, Fiehler J, Thomalla G, Alegiani A, Boeckh-Behrens, Wunderlich S, Ernemann U, Poli S, Siebert E, Nolte CH, Zweynert S, Bohner G, Ludolph A, Henn KH, Schäfer JH, Keil F, Röther J, Eckert B, Berrouschot J, Bormann A, Dorn F, Petzold G, Kraemer C, Leischner H, Trumm C, Tiedt S, Kellert L, Petersen M, Stögbauer F, Braun M, Hamann GF, Gröschel K, Uphaus T, Reich A, Nikoubashman O, Schellinger P, Borggrefe J, Hattingen J, Liman J, Ernst M. Side matters: differences in functional outcome and quality of life after thrombectomy in left and right hemispheric stroke. Neurol Res Pract 2022; 4:58. [PMID: 36411484 PMCID: PMC9677692 DOI: 10.1186/s42466-022-00223-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/12/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patients with a left (LHS) or right hemispheric stroke (RHS) differ in terms of clinical symptoms due to lateralization of specific cortical functions. Studies on functional outcome after stroke and endovascular thrombectomy (EVT) comparing both hemispheres showed conflicting results so far. The impact of stroke laterality on patient-reported health-related quality of life (HRQoL) after EVT has not yet been adequately addressed and still remains unclear. METHODS Consecutive stroke thrombectomy patients, derived from a multi-center, prospective registry (German Stroke Registry) between June 2015 and December 2019, were included in this study. At 90 days, outcome after EVT was assessed by the modified Rankin scale (mRS) and HRQoL using the European QoL-five dimensions questionnaire utility-index (EQ-5D-I; higher values indicate better HRQoL) in patients with LHS and RHS. Adjusted regression analysis was applied to evaluate the influence of stroke laterality on outcome after EVT. RESULTS In total, 5683 patients were analyzed. Of these, 2953 patients (52.8%) had LHS and 2637 (47.2%) RHS. LHS patients had a higher baseline NIHSS (16 vs. 13, p < 0.001) and a higher ASPECTS (9 vs. 8, p < 0.001) compared to RHS patients. Among survivors, patients with LHS less frequently had a self-reported affected mobility (p = 0.037), suffered less often from pain (p = 0.04) and anxiety/depression (p = 0.032) three months after EVT. After adjusting for confounders (age, sex, baseline NIHSS), LHS was associated with a better HRQoL (ß coefficient 0.04, CI 95% 0.017-0.063; p = 0.001), and better functional outcome assessed by lower values on the mRS (ß coefficient - 0.109, CI 95% - 0.217-0.000; p = 0.049). CONCLUSIONS Ninety days after EVT, LHS patients have a better functional outcome and HRQoL. Patients with RHS should be actively assessed and treated for pain, anxiety and depression to improve their HRQoL after EVT.
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Affiliation(s)
- Milani Deb-Chatterji
- grid.13648.380000 0001 2180 3484Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Fabian Flottmann
- grid.13648.380000 0001 2180 3484Department of Neuroradiological Diagnostics and Intervention, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Lukas Meyer
- grid.13648.380000 0001 2180 3484Department of Neuroradiological Diagnostics and Intervention, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Caspar Brekenfeld
- grid.13648.380000 0001 2180 3484Department of Neuroradiological Diagnostics and Intervention, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- grid.13648.380000 0001 2180 3484Department of Neuroradiological Diagnostics and Intervention, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- grid.13648.380000 0001 2180 3484Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Götz Thomalla
- grid.13648.380000 0001 2180 3484Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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Heinze M, Lebherz L, Rimmele DL, Frese M, Jensen M, Barow E, Lettow I, Kriston L, Gerloff C, Härter M, Thomalla G. Higher comorbidity burden is associated with lower self-reported quality of life after stroke. Front Neurol 2022; 13:1023271. [DOI: 10.3389/fneur.2022.1023271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022] Open
Abstract
IntroductionThis study assesses the association of comorbidity burden and polypharmacy with self-reported quality of life after stroke.Patients and methodsWe performed a post-hoc analysis of a prospective, single-center, observational study of outcome evaluation by patient-reported outcome measures in stroke clinical practice. Consecutive patients with acute ischemic stroke (AIS) were enrolled and self-reported health–related quality of life (HrQoL) was assessed 90 days after acute stroke using the Patient-reported Outcomes Measurement Information System 10-Question Short-Form (PROMIS-10). Comorbidities at baseline were assessed by the Charlson Comorbidity Index (CCI). Polypharmacy was defined as medication intake of ≥5 at baseline. We used linear regression analysis to study the association of CCI, polypharmacy and other clinical covariates with HrQoL after stroke.ResultsOf 781 patients (median age 76 years, 48.4% female) enrolled, 30.2% had a CCI Score ≥2, and 31.5% presented with polypharmacy. At follow up, 71 (9.1%) had died. In 409 (52.4%) reached for outcome evaluation, Global Physical Health T-Score was 43.8 ± 10 and Global Mental Health T-Score was 43.5 ± 8.76, indicating lower HrQoL than the average population. A CCI Score ≥2, higher NIHSS Score, female sex, dependency on others for dressing, toileting and mobility before index stroke, atrial fibrillation and hypertension were independent predictors of worse physical and mental health outcomes, while polypharmacy was not.ConclusionIn patients with AIS, high comorbidity burden and polypharmacy are frequent. Comorbidity burden at admission is independently associated with worse self-reported physical and mental health three months after stroke.
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Meinel TR, Lerch C, Fischer U, Beyeler M, Mujanovic A, Kurmann C, Siepen B, Scutelnic A, Müller M, Goeldlin M, Belachew NF, Dobrocky T, Gralla J, Seiffge D, Jung S, Arnold M, Wiest R, Meier R, Kaesmacher J. Multivariable Prediction Model for Futile Recanalization Therapies in Patients With Acute Ischemic Stroke. Neurology 2022; 99:e1009-e1018. [PMID: 35803722 PMCID: PMC9519255 DOI: 10.1212/wnl.0000000000200815] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/19/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Very poor outcome despite IV thrombolysis (IVT) and mechanical thrombectomy (MT) occurs in approximately 1 of 4 patients with ischemic stroke and is associated with a high logistic and economic burden. We aimed to develop and validate a multivariable prognostic model to identify futile recanalization therapies (FRTs) in patients undergoing those therapies. METHODS Patients from a prospectively collected observational registry of a single academic stroke center treated with MT and/or IVT were included. The data set was split into a training (N = 1,808, 80%) and internal validation (N = 453, 20%) cohort. We used gradient boosted decision tree machine learning models after k-nearest neighbor imputation of 32 variables available at admission to predict FRT defined as modified Rankin scale 5-6 at 3 months. We report feature importance, ability for discrimination, calibration, and decision curve analysis. RESULTS A total of 2,261 patients with a median (interquartile range) age of 75 years (64-83 years), 46% female, median NIH Stroke Scale 9 (4-17), 34% IVT alone, 41% MT alone, and 25% bridging were included. Overall, 539 (24%) had FRT, more often in MT alone (34%) as compared with IVT alone (11%). Feature importance identified clinical variables (stroke severity, age, active cancer, prestroke disability), laboratory values (glucose, C-reactive protein, creatinine), imaging biomarkers (white matter hyperintensities), and onset-to-admission time as the most important predictors. The final model was discriminatory for predicting 3-month FRT (area under the curve 0.87, 95% CI 0.87-0.88) and had good calibration (Brier 0.12, 0.11-0.12). Overall performance was moderate (F1-score 0.63 ± 0.004), and decision curve analyses suggested higher mean net benefit at lower thresholds of treatment (up to 0.8). CONCLUSIONS This FRT prediction model can help inform shared decision making and identify the most relevant features in the emergency setting. Although it might be particularly useful in low resource healthcare settings, incorporation of further multifaceted variables is necessary to further increase the predictive performance.
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Affiliation(s)
- Thomas Raphael Meinel
- From the Department of Neurology (T.M., C.L., M.B., B.S., A.S., M.M., M.G., D.S., S.J., M.A.), University Hospital Bern, Inselspital, University of Bern; Department of Neurology and Stroke Center (U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (A.M., C.K., N.F.B., T.D., J.G., R.W., R.M., J.K.), Support Center for Advanced Neuroimaging (R.W., R.M., J.K.), and Department of Diagnostic, Paediatric and Interventional Radiology (J.K.), University Hospital Bern, Inselspital, University of Bern, Switzerland.
| | - Christine Lerch
- From the Department of Neurology (T.M., C.L., M.B., B.S., A.S., M.M., M.G., D.S., S.J., M.A.), University Hospital Bern, Inselspital, University of Bern; Department of Neurology and Stroke Center (U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (A.M., C.K., N.F.B., T.D., J.G., R.W., R.M., J.K.), Support Center for Advanced Neuroimaging (R.W., R.M., J.K.), and Department of Diagnostic, Paediatric and Interventional Radiology (J.K.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Urs Fischer
- From the Department of Neurology (T.M., C.L., M.B., B.S., A.S., M.M., M.G., D.S., S.J., M.A.), University Hospital Bern, Inselspital, University of Bern; Department of Neurology and Stroke Center (U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (A.M., C.K., N.F.B., T.D., J.G., R.W., R.M., J.K.), Support Center for Advanced Neuroimaging (R.W., R.M., J.K.), and Department of Diagnostic, Paediatric and Interventional Radiology (J.K.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Morin Beyeler
- From the Department of Neurology (T.M., C.L., M.B., B.S., A.S., M.M., M.G., D.S., S.J., M.A.), University Hospital Bern, Inselspital, University of Bern; Department of Neurology and Stroke Center (U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (A.M., C.K., N.F.B., T.D., J.G., R.W., R.M., J.K.), Support Center for Advanced Neuroimaging (R.W., R.M., J.K.), and Department of Diagnostic, Paediatric and Interventional Radiology (J.K.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Adnan Mujanovic
- From the Department of Neurology (T.M., C.L., M.B., B.S., A.S., M.M., M.G., D.S., S.J., M.A.), University Hospital Bern, Inselspital, University of Bern; Department of Neurology and Stroke Center (U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (A.M., C.K., N.F.B., T.D., J.G., R.W., R.M., J.K.), Support Center for Advanced Neuroimaging (R.W., R.M., J.K.), and Department of Diagnostic, Paediatric and Interventional Radiology (J.K.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Christoph Kurmann
- From the Department of Neurology (T.M., C.L., M.B., B.S., A.S., M.M., M.G., D.S., S.J., M.A.), University Hospital Bern, Inselspital, University of Bern; Department of Neurology and Stroke Center (U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (A.M., C.K., N.F.B., T.D., J.G., R.W., R.M., J.K.), Support Center for Advanced Neuroimaging (R.W., R.M., J.K.), and Department of Diagnostic, Paediatric and Interventional Radiology (J.K.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Bernhard Siepen
- From the Department of Neurology (T.M., C.L., M.B., B.S., A.S., M.M., M.G., D.S., S.J., M.A.), University Hospital Bern, Inselspital, University of Bern; Department of Neurology and Stroke Center (U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (A.M., C.K., N.F.B., T.D., J.G., R.W., R.M., J.K.), Support Center for Advanced Neuroimaging (R.W., R.M., J.K.), and Department of Diagnostic, Paediatric and Interventional Radiology (J.K.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Adrian Scutelnic
- From the Department of Neurology (T.M., C.L., M.B., B.S., A.S., M.M., M.G., D.S., S.J., M.A.), University Hospital Bern, Inselspital, University of Bern; Department of Neurology and Stroke Center (U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (A.M., C.K., N.F.B., T.D., J.G., R.W., R.M., J.K.), Support Center for Advanced Neuroimaging (R.W., R.M., J.K.), and Department of Diagnostic, Paediatric and Interventional Radiology (J.K.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Madlaine Müller
- From the Department of Neurology (T.M., C.L., M.B., B.S., A.S., M.M., M.G., D.S., S.J., M.A.), University Hospital Bern, Inselspital, University of Bern; Department of Neurology and Stroke Center (U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (A.M., C.K., N.F.B., T.D., J.G., R.W., R.M., J.K.), Support Center for Advanced Neuroimaging (R.W., R.M., J.K.), and Department of Diagnostic, Paediatric and Interventional Radiology (J.K.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Martina Goeldlin
- From the Department of Neurology (T.M., C.L., M.B., B.S., A.S., M.M., M.G., D.S., S.J., M.A.), University Hospital Bern, Inselspital, University of Bern; Department of Neurology and Stroke Center (U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (A.M., C.K., N.F.B., T.D., J.G., R.W., R.M., J.K.), Support Center for Advanced Neuroimaging (R.W., R.M., J.K.), and Department of Diagnostic, Paediatric and Interventional Radiology (J.K.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Nebiyat Filate Belachew
- From the Department of Neurology (T.M., C.L., M.B., B.S., A.S., M.M., M.G., D.S., S.J., M.A.), University Hospital Bern, Inselspital, University of Bern; Department of Neurology and Stroke Center (U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (A.M., C.K., N.F.B., T.D., J.G., R.W., R.M., J.K.), Support Center for Advanced Neuroimaging (R.W., R.M., J.K.), and Department of Diagnostic, Paediatric and Interventional Radiology (J.K.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Tomas Dobrocky
- From the Department of Neurology (T.M., C.L., M.B., B.S., A.S., M.M., M.G., D.S., S.J., M.A.), University Hospital Bern, Inselspital, University of Bern; Department of Neurology and Stroke Center (U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (A.M., C.K., N.F.B., T.D., J.G., R.W., R.M., J.K.), Support Center for Advanced Neuroimaging (R.W., R.M., J.K.), and Department of Diagnostic, Paediatric and Interventional Radiology (J.K.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Jan Gralla
- From the Department of Neurology (T.M., C.L., M.B., B.S., A.S., M.M., M.G., D.S., S.J., M.A.), University Hospital Bern, Inselspital, University of Bern; Department of Neurology and Stroke Center (U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (A.M., C.K., N.F.B., T.D., J.G., R.W., R.M., J.K.), Support Center for Advanced Neuroimaging (R.W., R.M., J.K.), and Department of Diagnostic, Paediatric and Interventional Radiology (J.K.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - David Seiffge
- From the Department of Neurology (T.M., C.L., M.B., B.S., A.S., M.M., M.G., D.S., S.J., M.A.), University Hospital Bern, Inselspital, University of Bern; Department of Neurology and Stroke Center (U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (A.M., C.K., N.F.B., T.D., J.G., R.W., R.M., J.K.), Support Center for Advanced Neuroimaging (R.W., R.M., J.K.), and Department of Diagnostic, Paediatric and Interventional Radiology (J.K.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Simon Jung
- From the Department of Neurology (T.M., C.L., M.B., B.S., A.S., M.M., M.G., D.S., S.J., M.A.), University Hospital Bern, Inselspital, University of Bern; Department of Neurology and Stroke Center (U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (A.M., C.K., N.F.B., T.D., J.G., R.W., R.M., J.K.), Support Center for Advanced Neuroimaging (R.W., R.M., J.K.), and Department of Diagnostic, Paediatric and Interventional Radiology (J.K.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Marcel Arnold
- From the Department of Neurology (T.M., C.L., M.B., B.S., A.S., M.M., M.G., D.S., S.J., M.A.), University Hospital Bern, Inselspital, University of Bern; Department of Neurology and Stroke Center (U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (A.M., C.K., N.F.B., T.D., J.G., R.W., R.M., J.K.), Support Center for Advanced Neuroimaging (R.W., R.M., J.K.), and Department of Diagnostic, Paediatric and Interventional Radiology (J.K.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Roland Wiest
- From the Department of Neurology (T.M., C.L., M.B., B.S., A.S., M.M., M.G., D.S., S.J., M.A.), University Hospital Bern, Inselspital, University of Bern; Department of Neurology and Stroke Center (U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (A.M., C.K., N.F.B., T.D., J.G., R.W., R.M., J.K.), Support Center for Advanced Neuroimaging (R.W., R.M., J.K.), and Department of Diagnostic, Paediatric and Interventional Radiology (J.K.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Raphael Meier
- From the Department of Neurology (T.M., C.L., M.B., B.S., A.S., M.M., M.G., D.S., S.J., M.A.), University Hospital Bern, Inselspital, University of Bern; Department of Neurology and Stroke Center (U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (A.M., C.K., N.F.B., T.D., J.G., R.W., R.M., J.K.), Support Center for Advanced Neuroimaging (R.W., R.M., J.K.), and Department of Diagnostic, Paediatric and Interventional Radiology (J.K.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Johannes Kaesmacher
- From the Department of Neurology (T.M., C.L., M.B., B.S., A.S., M.M., M.G., D.S., S.J., M.A.), University Hospital Bern, Inselspital, University of Bern; Department of Neurology and Stroke Center (U.F.), University Hospital Basel and University of Basel; University Institute of Diagnostic and Interventional Neuroradiology (A.M., C.K., N.F.B., T.D., J.G., R.W., R.M., J.K.), Support Center for Advanced Neuroimaging (R.W., R.M., J.K.), and Department of Diagnostic, Paediatric and Interventional Radiology (J.K.), University Hospital Bern, Inselspital, University of Bern, Switzerland
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Fan Z, Li F, Chen H, Zhang L, Ji B. Aspiration versus Stent Retriever Thrombectomy in Posterior Circulation Stroke: A Systematic Review and Meta-Analysis. Eur Neurol 2022; 85:424-436. [PMID: 35947968 DOI: 10.1159/000525406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/22/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The management of posterior circulation stroke is primarily carried out by endovascular approaches including aspiration or stent retrevier thrombectomy. Existing reviews have attempted to comparatively evaluate their efficacy in terms of morbidity and mortality-related outcomes, however, with several limitations. Therefore, in this review, we attempt to address the gap in the existing literature by evaluating the comparative impact of stent retriever-based and aspiration-based thrombectomy interventions in posterior circulation stroke patients on the following parameters: overall procedure duration, recanalization time, rescue therapy usage, complication risk, and mortality risk. METHODS A systematic search of the academic literature was performed according to PRISMA guidelines across five databases. We conducted a random-effect meta-analysis to evaluate comparative outcomes, including procedural duration, time to recanalization, risk of complications, use of rescue therapy, and risk of mortality in patients with posterior circulation stroke undergoing stent retriever- and aspiration-based thrombectomies. We also performed comparative subgroup analyses to evaluate differences in outcomes between contact and manual aspiration interventions. RESULTS From 963 studies, we found nine eligible studies containing data on 840 patients. Meta-analysis revealed a large-to-medium size positive effect for stent retriever-based thrombectomy on overall procedure duration and recanalization compared to aspiration-based thrombectomy. Additional analysis revealed higher risk of complications and mortality in posterior circulation stroke patients undergoing stent retriever-based thrombectomy as compared to aspiration-based thrombectomy. We also observed that the use of rescue therapy was elevated in patients undergoing aspiration-based thrombectomy compared to stent retriever-based thrombectomy. CONCLUSION This study provides preliminary evidence for improved morbidity and mortality outcomes in posterior circulation stroke patients undergoing aspiration-based thrombectomies as compared to stent retriever-based thrombectomy. The study also provides evidence for improved endovascular outcomes for patients undergoing aspiration-based thrombectomies. The findings from this study can have implications in developing awareness among neurosurgeons for stratifying patients to manage posterior circulation stroke according to the risks associated with aspiration and stent retriever-based thrombectomies.
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Affiliation(s)
- Zhili Fan
- Preventive Treatment Center, Huzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Traditional Chinese Medicine, Huzhou, China
| | - Fei Li
- Department of Acupuncture and Trauma, Shenxin Community Health Service Center, Shanghai, China
| | - Hanyao Chen
- Department of Hand and Foot Surgery, Traditional Chinese Medical Hospital of Ninghai, Ningbo, China
| | - Le Zhang
- Department of Acupuncture and Massage, Traditional Chinese Medical Hospital of Ninghai, Ningbo, China
| | - Bing Ji
- Preventive Treatment Center, Huzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Traditional Chinese Medicine, Huzhou, China
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Joundi RA, Adekanye J, Leung AA, Ronksley P, Smith EE, Rebchuk AD, Field TS, Hill MD, Wilton SB, Bresee LC. Health State Utility Values in People With Stroke: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2022; 11:e024296. [PMID: 35730598 PMCID: PMC9333363 DOI: 10.1161/jaha.121.024296] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/21/2022] [Indexed: 12/25/2022]
Abstract
Background Health state utility values are commonly used to provide summary measures of health-related quality of life in studies of stroke. Contemporaneous summaries are needed as a benchmark to contextualize future observational studies and inform the effectiveness of interventions aimed at improving post-stroke quality of life. Methods and Results We conducted a systematic search of the literature using Medline, EMBASE, and Web of Science from January 1995 until October 2020 using search terms for stroke, health-related quality of life, and indirect health utility metrics. We calculated pooled estimates of health utility values for EQ-5D-3L, EQ-5D-5L, AQoL, HUI2, HUI3, 15D, and SF-6D using random effects models. For the EQ-5D-3L we conducted stratified meta-analyses and meta-regression by key subgroups. We screened 14 251 abstracts and 111 studies met our inclusion criteria (sample size range 11 to 12 447). EQ-5D-3L was reported in 78% of studies (study n=87; patient n=56 976). The pooled estimate for EQ-5D-3L at ≥3 months following stroke was 0.65 (95% CI, 0.63-0.67), which was ≈20% below population norms. There was high heterogeneity (I2>90%) between studies, and estimates differed by study size, case definition of stroke, and country of study. Women, older individuals, those with hemorrhagic stroke, and patients prior to discharge had lower pooled EQ-5D-3L estimates. Conclusions Pooled estimates of health utility for stroke survivors were substantially below population averages. We provide reference values for health utility in stroke to support future clinical and economic studies and identify subgroups with lower healthy utility. Registration URL: https://www.crd.york.ac.uk/prospero/. Unique Identifier: CRD42020215942.
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Affiliation(s)
- Raed A. Joundi
- Department of Clinical NeurosciencesUniversity of CalgaryAlbertaCanada
- Division of NeurologyHamilton Health SciencesMcMaster University & Population Health Research InstituteHamiltonOntarioCanada
| | | | | | | | | | | | - Thalia S. Field
- University of British ColumbiaVancouverBritish ColumbiaCanada
| | | | | | - Lauren C. Bresee
- Department of Community Health SciencesUniversity of CalgaryAlbertaCanada
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11
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Ospel JM, Schaafsma JD, Leslie-Mazwi TM, Amin-Hanjani S, Asdaghi N, Gordon-Perue GL, Couillard P, Hadidi NN, Bushnell C, McCullough LD, Goyal M. Toward a Better Understanding of Sex- and Gender-Related Differences in Endovascular Stroke Treatment: A Scientific Statement From the American Heart Association/American Stroke Association. Stroke 2022; 53:e396-e406. [PMID: 35695016 DOI: 10.1161/str.0000000000000411] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are many unknowns when it comes to the role of sex in the pathophysiology and management of acute ischemic stroke. This is particularly true for endovascular treatment (EVT). It has only recently been established as standard of care; therefore, data are even more scarce and conflicting compared with other areas of acute stroke. Assessing the role of sex and gender as isolated variables is challenging because they are closely intertwined with each other, as well as with patients' cultural, ethnic, and social backgrounds. Nevertheless, a better understanding of sex- and gender-related differences in EVT is important to develop strategies that can ultimately improve individualized outcome for both men and women. Disregarding patient sex and gender and pursuing a one-size-fits-all strategy may lead to suboptimal or even harmful treatment practices. This scientific statement is meant to outline knowledge gaps and unmet needs for future research on the role of sex and gender in EVT for acute ischemic stroke. It also provides a pragmatic road map for researchers who aim to investigate sex- and gender-related differences in EVT and for clinicians who wish to improve clinical care of their patients undergoing EVT by accounting for sex- and gender-specific factors. Although most EVT studies, including those that form the basis of this scientific statement, report patient sex rather than gender, open questions on gender-specific EVT differences are also discussed.
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12
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Pinter D, Fandler-Höfler S, Fruhwirth V, Berger L, Bachmaier G, Horner S, Eppinger S, Kneihsl M, Enzinger C, Gattringer T. Relevance of Cognition and Emotion for Patient-Reported Quality of Life After Stroke in Working Age: An Observational Cohort Study. Front Neurol 2022; 13:869550. [PMID: 35547373 PMCID: PMC9081872 DOI: 10.3389/fneur.2022.869550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background Patient-reported quality of life (QoL) may help to capture sequela of stroke more comprehensively. We aimed to investigate QoL in working age persons with ischemic stroke regarding impaired domains and identify factors associated with better QoL. Methods We invited persons with stroke aged 18–55 years to participate in this prospective observational study. We assessed QoL and self-rated health using the EuroQol 5 Dimension questionnaire (EQ-5D) during hospital stay (baseline) and at 3-months follow-up (FU). Additionally, the National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), cognition (Montreal Cognitive assessment, MOCA), emotion (Hospital Anxiety and Depression Scale), and return to work were evaluated. We used hierarchical regression to identify predictors of QoL (self-rated health and QoL Index score) at FU. Results We included 138 persons with stroke (mean age = 43.6 ± 10 years; 41% female; median admission NIHSS = 2), of whom 99 participated at FU. QoL Index and self-rated health were correlated with NIHSS, mRS, anxiety, and depression at both timepoints. Although 80% had favorable functional outcome at FU (mRS < 2), high proportions of these persons reported problems in the “Pain and/or Discomfort” (25.3%) and “Anxiety/Depression” (22.8%) dimensions. Only discharge NIHSS and baseline MOCA independently predicted self-rated health at FU. Female sex, higher discharge NIHSS, and higher baseline depression scores predicted worse QoL Index scores at FU. Conclusions Three months post-stroke, working age persons with stroke frequently reported problems in dimensions not assessed by the routinely used mRS. Despite correlations between clinical scales and QoL, patient-reported outcomes and screening for cognition and emotion ensure a more comprehensive assessment of post-stroke consequences relevant for QoL.
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Affiliation(s)
- Daniela Pinter
- Department of Neurology, Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Austria.,Department of Neurology, Medical University of Graz, Graz, Austria
| | | | - Viktoria Fruhwirth
- Department of Neurology, Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Austria.,Department of Neurology, Medical University of Graz, Graz, Austria
| | - Lisa Berger
- Department of Neurology, Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Austria.,Department of Neurology, Medical University of Graz, Graz, Austria
| | - Gerhard Bachmaier
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Susanna Horner
- Department of Neurology, Medical University of Graz, Graz, Austria
| | | | - Markus Kneihsl
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Christian Enzinger
- Department of Neurology, Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Austria.,Department of Neurology, Medical University of Graz, Graz, Austria.,Division of Neuroradiology, Department of Radiology, Vascular and Interventional Radiology, Medical University of Graz, Graz, Austria
| | - Thomas Gattringer
- Department of Neurology, Medical University of Graz, Graz, Austria.,Division of Neuroradiology, Department of Radiology, Vascular and Interventional Radiology, Medical University of Graz, Graz, Austria
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13
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Zhang P, Shen HJ, Chen L, Zhu X, Zhang MM, Jiang Y, Yang PF, Zhang L, Xing PF, Ye XF, Lou M, Yin CG, Deng BQ, Wu T, Zhang YW, Liu JM. Patient-Reported Anxiety/Depression After Endovascular Thrombectomy: A post-hoc Analysis of Direct-MT Trial. Front Neurol 2022; 13:811629. [PMID: 35222248 PMCID: PMC8864177 DOI: 10.3389/fneur.2022.811629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/10/2022] [Indexed: 11/17/2022] Open
Abstract
Objective To analyze the effect of endovascular thrombectomy (EVT) alone vs. EVT after an intravenous (IV) alteplase of ischemic stroke on a patient-reported anxiety/depression, and to identify predictors of patient-reported anxiety/depression by analyzing data from Direct Intraarterial Thrombectomy in Order to Revascularize the patients with Acute Ischemic Stroke with a Large Vessel Occlusion Efficiently in Chinese Tertiary Hospitals: a Multicenter Randomized Clinical Trial (DIRECT-MT). Methods Patients with acute ischemic stroke (AIS), triggered by a large-vessel occlusion in the anterior circulation, were randomly allocated to undergo an EVT after IV alteplase (combination-therapy group) or an EVT alone (EVT-alone group) at a 1:1 ratio in DIRECT-MT. Patients in both groups were followed up for 90 days (±14 days) after stroke using a structured modified Ranking Scale (mRS), a Barthel Index (BI), and a 5-Dimensional European Quality of Life Scale (EQ-5D-5L). Patients who returned EQ-5D-5L were included. The EQ-5D-5L anxiety/depression dimension was used to analyze the patient-reported anxiety/depression. First, differences in patient-reported anxiety/depression were compared between the combination-therapy group and the EVT-alone group. Then, the baseline and influencing factors between the anxiety/depression group and no anxiety/depression group were analyzed using univariate regression analysis. Finally, variables with p < 0.1 in univariate regression were subjected to multivariable binary regression analysis to screen independent predictors for patient-reported anxiety /depression after ischemic stroke. Results : Five hundred fifteen patients returned the EQ-5D-5L in Direct-MT. Of these patients, 226 (43.88%) reported a level of anxiety/depression, and about 7% reported a severe or extremely severe anxiety/depression. The patient-reported anxiety/depression in the EVT-alone group was significantly higher than that in the combination-therapy group (48.26% vs. 39.45%, p = 0.04). The clinical outcomes were significantly different between the no Anxiety/Depression Group and the anxiety/depression group (mRS at 90 days:2 vs 3, p < 0.001; BI of 95 or 100 at 90 days: 73.36% vs 42.04%, p < 0.001; EQ-5D-5l utility indexes at 90 days:0.96 vs.57, p < 0.001). Logistic regression analysis showed that allocation to thrombolysis before EVT strategy was inversely associated with anxiety/depression [0.61(0.40, 0.94), p = 0.03], an insular cortex ischemia, and National Institute of Health Strocke Scale (NIHSS) at 7 days were positively associated with anxiety/depression [2.04(1.07, 3.90), p = 0.03; 1.07(1.03, 1.12), p < 0.001]. Conclusions Patient-reported anxiety/depression may suggest that there is a benefit to administering intravenous alteplase before EVT. It may also indicate that it is better to provide IV alteplase before EVT, rather than EVT alone according to patient-reported anxiety/depression. Future research should consider not only the motor function impairments but also the patient-reported mental problems as measures of treatment efficacy in patients with stroke (DIRECT-MT ClinicalTrials.gov number, NCT03469206).
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Affiliation(s)
- Ping Zhang
- Department of Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Hong-jian Shen
- Department of Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Lei Chen
- Department of Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xuan Zhu
- Department of Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Min-min Zhang
- Department of Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yi Jiang
- Department of Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Peng-fei Yang
- Department of Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Lei Zhang
- Department of Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Peng-fei Xing
- Department of Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xiao-fei Ye
- Department of Statistics, Naval Medical University, Shanghai, China
| | - Min Lou
- Department of Neurology, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Cong-guo Yin
- Department of Neurology, Hangzhou First People's Hospital, Hangzhou, China
| | - Ben-qiang Deng
- Department of Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Tao Wu
- Department of Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
- Tao Wu
| | - Yong-wei Zhang
- Department of Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
- *Correspondence: Yong-wei Zhang
| | - Jian-min Liu
- Department of Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
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14
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Deb-Chatterji M, Pinho J, Flottmann F, Meyer L, Broocks G, Brekenfeld C, Reich A, Fiehler J, Gerloff C, Thomalla G. Health-related quality of life after thrombectomy in young-onset versus older stroke patients: a multicenter analysis. J Neurointerv Surg 2021; 14:1145-1150. [PMID: 34876497 DOI: 10.1136/neurintsurg-2021-017991] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/06/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Information is lacking on self-reported health-related quality of life (HRQoL) as a complementary outcome measure in addition to the modified Rankin scale (mRS) in young patients with ischemic stroke after endovascular thrombectomy (EVT) compared with older patients. METHODS Data on consecutive patients with stroke who underwent thrombectomy (June 2015-2019) from a multicenter prospective registry (German Stroke Registry) were analyzed. HRQoL was measured by the European QoL-5 dimension questionnaire utility index (EQ-5D-I; higher values indicate better HRQoL) 3 months after stroke in patients aged ≤55 and >55 years. Multivariate regression analyses identified predictors of better HRQoL. RESULTS Of 4561 included patients, 526 (11.5%) were ≤55 years old. Young-onset patients had a better outcome assessed by mRS (mRS 0-2: 64.3% vs 31.8%, p<0.001) and EQ-5D-I (mean 0.639 vs 0.342, p<0.001). Young survivors after EVT had fewer complaints in the EQ-5D domains mobility (p<0.001), self-care (p<0.001), usual activities (p<0.001) and pain/discomfort (p=0.008), whereas no difference was observed in anxiety/depression (p=0.819). Adjusted regression analysis for 90-day mRS showed no difference in HRQoL between the two subgroups of patients. Lower age, National Institutes of Health Stroke Scale score and pre-stroke mRS, a higher Alberta Stroke Program Early CT Score, concomitant intravenous thrombolysis therapy and successful recanalization were associated with better HRQoL in both patient subgroups. CONCLUSIONS Young-onset stroke patients have a better HRQoL after EVT than older patients. Their higher HRQoL is mainly explained by less physical disability assessed by mRS. Depressive symptoms should be actively assessed and targeted in rehabilitation therapies of young-onset stroke patients to improve quality of life after stroke.
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Affiliation(s)
- Milani Deb-Chatterji
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - João Pinho
- Department of Neurology, RWTH Aachen University, Aachen, Nordrhein-Westfalen, Germany
| | - Fabian Flottmann
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Caspar Brekenfeld
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Arno Reich
- Department of Neurology, RWTH Aachen University, Aachen, Nordrhein-Westfalen, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Goetz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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15
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Kainz A, Meisinger C, Linseisen J, Kirchberger I, Zickler P, Naumann M, Ertl M. Changes of Health-Related Quality of Life Within the 1st Year After Stroke-Results From a Prospective Stroke Cohort Study. Front Neurol 2021; 12:715313. [PMID: 34671308 PMCID: PMC8520951 DOI: 10.3389/fneur.2021.715313] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: As prospective data on long-term patient-reported outcome measures (PROMs) to assess Health related Quality of Life (HRQoL) after stroke are still scarce, this study examined the long-term course of PROMs and investigated influential factors such as recanalization therapies. Materials and Methods: A total of 945 (mean age 69 years; 56% male) stroke patients were enrolled with a personal interview and chart review performed at index event. One hundred forty (15%) patients received thrombolysis (IVT) and 53 (5%) patients received endovascular therapy (ET) or both treatments as bridging therapy (BT). After 3 and 12 months, a follow-up was conducted using a postal questionnaire including subjective quality of life EQ-5D-5L (European Quality of Life 5 Dimensions). At all time-points, Modified Rankin Scale (mRS) was additionally used to quantify functional stroke severity. Differences between therapy groups were identified using post-hoc-tests. Linear and logistic regression analyses were used to identify predictors of outcomes. Results: Recanalization therapies were associated with significant improvements of NIHSS (National Institutes of Health Stroke Scale [regression coefficient IVT 1.21 (p = 0.01) and ET/BT 7.6; p = 0.001] and mRS (modified Rankin Scale) [regression coefficient IVT 0.83; p = 0.001 and ET/BT 2.0; p = 0.001] between admission and discharge compared to patients with stroke unit therapy only, with a trend toward improvement of EQ-5D after 12 months [regression coefficient 4.67 (p = 0.17)] with IVT. HRQoL was considerably impaired by stroke and increased steadily in 3- and 12-months follow-up in patients with (mean EQ-5D from 56 to 68) and without recanalization therapy (mean EQ-5D from 62 to 68). In severe strokes a major and significant improvement was only detected during period of 3 to 12 months (p = 0.03 in patients with and p = 0.005 in patients without recanalization therapy). Conclusions: Despite significant and continuous improvements after stroke the HRQoL after 12 months remained below the age-matched general population, but was still unexpectedly high in view of the accumulation of permanent disabilities in up to 30% of the patients. Especially in severe strokes, it is important to evaluate HRQoL beyond a 3-months follow-up as improvements became significant only between 3 months and 1 year.
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Affiliation(s)
- Anabelle Kainz
- Department of Neurology and Clinical Neurophysiology, University Hospital Augsburg, Augsburg, Germany
| | - Christa Meisinger
- Chair of Epidemiology, University Augsburg, University Hospital Augsburg, Augsburg, Germany.,Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Jakob Linseisen
- Chair of Epidemiology, University Augsburg, University Hospital Augsburg, Augsburg, Germany.,Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Inge Kirchberger
- Chair of Epidemiology, University Augsburg, University Hospital Augsburg, Augsburg, Germany.,Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Philipp Zickler
- Department of Neurology and Clinical Neurophysiology, University Hospital Augsburg, Augsburg, Germany
| | - Markus Naumann
- Department of Neurology and Clinical Neurophysiology, University Hospital Augsburg, Augsburg, Germany
| | - Michael Ertl
- Department of Neurology and Clinical Neurophysiology, University Hospital Augsburg, Augsburg, Germany
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16
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Reverté-Villarroya S, Dávalos A, Font-Mayolas S, Berenguer-Poblet M, Sauras-Colón E, López-Pablo C, Sanjuan-Menéndez E, Muñoz-Narbona L, Suñer-Soler R. Coping Strategies, Quality of Life, and Neurological Outcome in Patients Treated with Mechanical Thrombectomy after an Acute Ischemic Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176014. [PMID: 32824892 PMCID: PMC7503747 DOI: 10.3390/ijerph17176014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 01/29/2023]
Abstract
New reperfusion therapies have improved the clinical recovery rates of acute ischemic stroke patients (AISP), but it is not known whether other factors, such as the ability to cope, might also have an effect. The aim of this study was to evaluate the effect of endovascular treatment (EVT) on coping strategies, quality of life, and neurological and functional outcomes in AISP at 3 months and 1 year post-stroke. A multicenter, prospective, longitudinal, and comparative study of a sub-study of the participants in the Endovascular Revascularization with Solitaire Device versus Best Medical Therapy in Anterior Circulation Stroke within 8 Hours (REVASCAT) clinical trial was conducted after recruiting from two stroke centers in Catalonia, Spain. The cohort consisted of 82 ischemic stroke patients (n = 42 undergoing EVT and n = 40 undergoing standard best medical treatment (BMT) as a control group), enrolled between 2013–2015. We assessed the coping strategies using the Brief Coping Questionnaire (Brief-COPE-28), the health-related quality of life (HRQoL) with the EQ-5D questionnaire, and the neurological and functional status using the National Institute of Health Stroke Scale (NIHSS), Barthel Index (BI), modified Rankin Scale (mRS), and Stroke Impact Scale-16 (SIS-16). Bivariate analyses and multivariate linear regression models were used. EVT patients were the ones that showed better neurological and functional outcomes, and more patients presented reporting no pain/discomfort at 3 months; paradoxically, problem-focused coping strategies were found to be significantly higher in patients treated with BMT at 1 year.
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Affiliation(s)
- Silvia Reverté-Villarroya
- Department of Nursing, Rovira Virgili University, Campus Terres de l’Ebre, 43500 Tortosa, Spain; (M.B.-P.); (C.L.-P.)
- Hospital de Tortosa Verge de la Cinta, Pere Virgili Institut, 43500 Tortosa, Spain;
- Correspondence:
| | - Antoni Dávalos
- RETICS Research Group, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (A.D.); (L.M.-N.)
| | | | - Marta Berenguer-Poblet
- Department of Nursing, Rovira Virgili University, Campus Terres de l’Ebre, 43500 Tortosa, Spain; (M.B.-P.); (C.L.-P.)
- Hospital de Tortosa Verge de la Cinta, Pere Virgili Institut, 43500 Tortosa, Spain;
| | - Esther Sauras-Colón
- Hospital de Tortosa Verge de la Cinta, Pere Virgili Institut, 43500 Tortosa, Spain;
| | - Carlos López-Pablo
- Department of Nursing, Rovira Virgili University, Campus Terres de l’Ebre, 43500 Tortosa, Spain; (M.B.-P.); (C.L.-P.)
- Hospital de Tortosa Verge de la Cinta, Pere Virgili Institut, 43500 Tortosa, Spain;
| | | | - Lucía Muñoz-Narbona
- RETICS Research Group, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (A.D.); (L.M.-N.)
| | - Rosa Suñer-Soler
- Department of Nursing, University of Girona, 17003 Girona, Spain;
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