Mechanical thrombectomy is efficacious in patients with pre‐stroke moderate disability

Abstract

Introduction: Patients with ischaemic stroke due to large vessel occlusion (LVO) can be treated successfully with mechanical thrombectomy (MT) and/or intravenous thrombolysis. In the landmark trials, MT was only performed for those with no functional disability prior to stroke (mRS 0-2). There are limited data available regarding clinical outcomes for patients with pre-stroke moderate disability (mRS ≥ 3). The aims of this study were to analyse the clinical outcomes and financial implications in regard to accommodation costs of performing MT in patients with pre-stroke mRS = 3. Methods: An observational cohort study was performed of 802 patients with anterior circulation LVO ischaemic stroke who underwent MT between October 2016 and January 2020 at three tertiary hospitals. Patient demographics, premorbid mRS, stroke and interventional data, 90-day mRS and accommodation situation were recorded. Results: Eighty-two patients with anterior circulation LVO ischaemic stroke were pre-stroke mRS 3. 38% had a good clinical outcome, as defined by mRS 3 at 90 days. Mortality rate was 38%. The majority of patients presented from home (83%) and greater than one third of those returned home during the 90 days post treatment. 81% of patients had no increase in accommodation cost at 90 days. Conclusion: Patients with pre-stroke moderate disability may benefit from MT if they are appropriately selected. This may result in fewer patients requiring nursing home placement and less financial burden on the public health system, indicating significant savings are possible.

Endovascular treatment of acute ischemic stroke in patients with pre-morbid disability: a meta-analysis

“…A total of 14 articles from 13 author groups were included. Ten studies compared outcomes between patients with versus without pre-morbid stroke disability treated with EVT 14–24. We found two studies comparing patients with pre-morbid disability treated with EVT to pre-morbidly disabled patients receiving medical management alone 25 26.…”

“…All the studies were observational, all except24 one reported prospectively collected data, and five were multicenter 14 19 22. Characteristics of the included studies are summarized in table 1.…”

Outcome of Endovascular Thrombectomy in Pre-stroke Dependent Patients With Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

“…After reading the full-text articles, six studies were excluded due to having included different populations in each group, two studies were excluded for insufficient data regarding the mRS scores of the participants, one study was excluded for not having a comparison group, and one study was excluded for not using the mRS score as the classification score for disability. Finally, six studies published between 2017 and 2021 were included in our meta-analysis ( 14 , 15 , 17 , 18 , 20 , 21 ), involving 4,543 cases with no prior disability and 591 cases with prior functional dependency. Six studies were included for the quantitative analysis of sICH ( 14 , 15 , 17 , 18 , 20 , 21 ), while all but one study ( 15 ) were included in the meta-analysis of clinical outcome and mortality.…”

“…Finally, six studies published between 2017 and 2021 were included in our meta-analysis ( 14 , 15 , 17 , 18 , 20 , 21 ), involving 4,543 cases with no prior disability and 591 cases with prior functional dependency. Six studies were included for the quantitative analysis of sICH ( 14 , 15 , 17 , 18 , 20 , 21 ), while all but one study ( 15 ) were included in the meta-analysis of clinical outcome and mortality. The latter study was excluded due to having a different definition for clinical outcome (mRS score of 4 or higher was defined as unfavorable outcome).…”

Data_Sheet_1.docx

“…Selection and Characteristics of the Included Studies (14,15,17,18,20,21), involving 4,543 cases with no prior disability and 591 cases with prior functional dependency. Six studies were included for the quantitative analysis of sICH (14,15,17,18,20,21), while all but one study (15) were included in the meta-analysis of clinical outcome and mortality. The latter study was excluded due to having a different definition for clinical outcome (mRS score of 4 or higher was defined as unfavorable outcome).…”