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

Adamou, Antonis; Gkana, A.; Mavrovounis, Georgios; Beltsios, Eleftherios T.; Kastrup, Andreas; Papanagiotou, Panagiotis

doi:10.3389/fneur.2022.880046

Cited by 13 publications

(4 citation statements)

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“…Even though pre-stroke disability was associated with higher mortality and worse neurological functional outcomes at 3 months, the use of IV thrombolysis appeared to be of benefit to some previously dependent patients ( 21 ). A recent meta-analysis of five observational studies of MT concluded a “good clinical outcome,” which was defined as an mRS score of 0–2 or a return to the pre-stroke mRS score in 27% of patients at 3 months ( 10 ). However, the analysis was not restricted to older patients, thus explaining that the mean age was lower than in our study.…”

Section: Discussionmentioning

confidence: 99%

“…Older patients have been poorly represented in randomized clinical trials while they have a less favorable functional outcome after stroke ( 4 ). Nevertheless, they seem to benefit as much as young patients from both IVT ( 5 , 6 ) and MT ( 7 – 10 ) regarding 3- and 6-month outcomes ( 6 – 9 ) but few studies described long-term outcomes ( 11 ). In addition, patients with a prior-to-stroke disability defined as a pre-morbid modified Rankin scale (mRS) score ( 12 ) of either >2 or >3 were excluded from most trials of acute IS revascularization therapy, regardless of age.…”

Section: Introductionmentioning

confidence: 99%

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Functional outcomes of ischemic stroke patients aged over 80 years treated with acute revascularization therapy according to pre-morbid disability: a PARADISE study

et al. 2023

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IntroductionAging population leads to changes in the profile of patients with acute ischemic stroke (IS), and older adults were largely excluded from randomized clinical trials of acute revascularization therapy. This study aimed to assess functional outcomes of treated IS patients > 80 years old according to prior disability and identify associated factors.MethodsConsecutively older patients with acute IS treated with either IV thrombolysis and/or mechanical thrombectomy were enrolled between 2016 and 2019. Pre-morbid disability was assessed using the modified Rankin Scale (mRS) score, and patients were classified as being independent (mRS score, 0–2) or having pre-existing disability (mRS score, 3–5). A multivariable logistic regression analysis was performed to assess factors associated with a poor functional outcome (mRS score > 3) at 3 and 12 months in each group of patients.ResultsAmong 300 included patients (mean age: 86.3 ± 4.6 years, 63% women, median NIHSS score: 14, IQR: 8–19), 100 had a pre-existing disability. In patients with a pre-morbid mRS score of 0–2, 51% had mRS >3 including 33% of deaths at 3 months. At 12 months, 50% had a poor outcome including 39% of deaths. In patients with a pre-morbid mRS score of 3–5, 71% had a poor outcome at 3 months including 43% of deaths, and at 12 months, 76% had mRS >3 including 52% of deaths. In multivariable models, the NIHSS score at 24 h was independently associated with poor outcomes at 3 and 12 months in both patients with (OR = 1.32; 95% CI: 1.16–1.51, p < 0.001 for 12 months outcome) or without (OR = 1.31; 95% CI: 1.19–1.44, p < 0.001 for 12 months outcome) pre-morbid disability.ConclusionAlthough a large proportion of older patients with a pre-existing disability had a poor functional outcome, they did not differ from their non-impaired counterparts regarding prognostic factors. This means that there were no factors in our study that would help clinicians identify patients at risk of poor functional outcomes after revascularization therapy among those with prior disability. Further studies are needed to better understand the post-stroke trajectory of older IS patients with a pre-morbid disability.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Functional outcomes of ischemic stroke patients aged over 80 years treated with acute revascularization therapy according to pre-morbid disability: a PARADISE study

et al. 2023

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“…Future work in pre-hospital and hospital settings should also consider combining physiological factors with other nonstroke characteristics which may have a bearing on thrombectomy outcome such as frailty, pre-stroke dependency and comorbidities (Adamou et al, 2022;Tan et al, 2022;Barow et al, 2023). Although some have been included in previously published thrombectomy outcome scores (Kremers et al, 2021), especially pre-stroke dependency, it has not yet been demonstrated that they are accurate when used by non-specialist practitioners making early triage decisions towards thrombectomy providers.…”

Section: Discussionmentioning

confidence: 99%

Associations between basic physiological observations recorded pre-thrombectomy and functional outcome: a systematic review and meta-analysis

Lumley,

Shaw,

Morris

et al. 2023

Front. Stroke

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IntroductionMechanical thrombectomy results in more favourable functional outcomes for patients with acute large vessel occlusion (LVO) stroke. Key clinical determinants of thrombectomy outcome include symptom severity, age and time from onset to treatment, but associations have also been reported with baseline physiological observations including systolic/diastolic blood pressure (SBP/DBP), blood/serum glucose, atrial fibrillation and conscious level. As these items are routinely available during initial emergency assessment, they might help to inform early prehospital and hospital triage decisions if evidence consistently shows associations with post-thrombectomy outcome. We undertook a meta-analysis of studies reporting pre-thrombectomy physiological observations and functional outcome.MethodPRISMA guidelines were followed to search electronic bibliographies, select articles and extract data. Medline, PubMed, Cochrane HTA, Cochrane Central and Embase were searched. Included articles were observational or interventional thrombectomy studies published between 01/08/2004-19/04/2023 reporting 3-month modified Rankin Scale, split as favourable (0–2) and unfavourable (3–6). A modified version of the Quality in Prognostic Studies (QUIPS) tool was used to assess risk of bias. RevMan 5 was used to calculate Inverse Variance with Weighted Mean Differences (WMD) and Mantel-Haenszel Odds Ratios (OR) for continuous and categorical factors respectively.ResultsThirty seven studies were eligible from 8,687 records. Significant associations were found between unfavourable outcome and higher blood/serum glucose as a continuous (WMD = 1.34 mmol/l (95%CI 0.97 to 1.72); 19 studies; n = 3122) and categorical (OR = 2.44 (95%CI 1.9 to 3.14) variable; 6 studies; n = 5481), higher SBP (WMD = 2.98 mmHg (95%CI 0.86 to 5.11); 16 studies; n = 4,400), atrial fibrillation (OR = 1.48 (95%CI 1.08 to 2.03); 3 studies; n = 736), and lower Glasgow Coma Scale (WMD = −2.72 (95%CI −4.01 to −1.44); 2 studies; n = 99). No association was found with DBP (WMD = 0.36 mmHg (95%CI −0.76 to 1.49); 13 studies; n = 3,614).ConclusionBasic physiological observations might assist early triage decisions for thrombectomy and could be used in combination with other information to avoid futile treatment and ambulance transfers. It is important to acknowledge that data were only from thrombectomy treated patients in hospital settings and it cannot be assumed that the predictors identified are independent or that modification can change outcome. Further work is needed to establish the optimal combination of prognostic factors for clinical care decisions.

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“…A systematic review and meta-analysis of six observational studies including 591 patients with pre-stroke dependency found a higher rate of unfavourable clinical outcome and a higher mortality rate when undergoing endovascular treatment than in those with no previous disability. 101 However, a substantial proportion of these patients recovered well after treatment, indicating possible benefit in selected patients. More data from randomised controlled trials are needed, and investigators should reconsider what constitutes a so-called good outcome.…”

Section: Future Directionsmentioning

confidence: 98%

Advances in mechanical thrombectomy for acute ischaemic stroke

Raha,

Hall,

Malik

et al. 2023

bmjmed

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Mechanical thrombectomy is a ground breaking treatment for acute ischaemic stroke caused by occlusion of a large vessel. Its efficacy over intravenous thrombolysis has been proven in multiple trials with a lower number needed to treat than percutaneous coronary intervention for acute myocardial infarction. However, access to this key treatment modality remains limited with a considerable postcode lottery across the UK and many parts of the world. The evidence base for mechanical thrombectomy dates back to 2015. Since then, there have been important advances in establishing and widening the criteria for treatment. This narrative review aims to summarise the current evidence base and latest advances for physicians and academics with an interest in recanalisation treatments for acute ischaemic stroke.

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

Cited by 13 publications

References 36 publications

Functional outcomes of ischemic stroke patients aged over 80 years treated with acute revascularization therapy according to pre-morbid disability: a PARADISE study

Functional outcomes of ischemic stroke patients aged over 80 years treated with acute revascularization therapy according to pre-morbid disability: a PARADISE study

Associations between basic physiological observations recorded pre-thrombectomy and functional outcome: a systematic review and meta-analysis

Advances in mechanical thrombectomy for acute ischaemic stroke

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