Impact of pre-stroke dependency on outcome after endovascular therapy in acute ischemic stroke.

Oesch, Lisa; Arnold, Marcel; Bernasconi, Corrado; Kaesmacher, Johannes; Fischer, Urs; Mosimann, Pascal; Jung, Simon; Meinel, Thomas; Göldlin, Martina; Heldner, Mirjam; Volbers, Bastian; Gralla, Jan; Sarikaya, Hakan (2021). Impact of pre-stroke dependency on outcome after endovascular therapy in acute ischemic stroke. Journal of neurology, 268(2), pp. 541-548. Springer-Medizin-Verlag 10.1007/s00415-020-10172-3

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BACKGROUND AND PURPOSE

Current demographic changes indicate that more people will be care-dependent due to increasing life expectancy. Little is known about impact of preexisting dependency on stroke outcome after endovascular treatment (EVT).

METHODS

We compared prospectively collected baseline and outcome data of previously dependent vs. independent stroke patients (prestroke modified Rankin Scale score of 3-5 vs. 0-2) treated with EVT. Outcome measures were favorable 3-month outcome (mRS ≤ 3 for previously dependent and mRS ≤ 2 for independent patients, respectively), death and symptomatic intracranial hemorrhage (sICH).

RESULTS

Among 1247 patients, 84 (6.7%) were dependent before stroke. They were older (81 vs. 72 years of age), more often female (61.9% vs. 46%), had a higher stroke severity at baseline (NIHSS 18 vs. 15 points), more often history of previous stroke (32.9% vs. 9.1%) and more vascular risk factors than independent patients. Favorable outcome and mortality were to the disadvantage of independent patients (26.2% vs. 44.4% and 46.4% vs. 25.5%, respectively), whereas sICH was comparable in both cohorts (4.9% vs. 5%). However, preexisting dependency was not associated with clinical outcome and mortality after adjusting for outcome predictors (OR 1.076, 95% CI 0.612-1.891; p = 0.799 and OR 1.267, 95% CI 0.758-2.119; p = 0.367, respectively).

CONCLUSION

Our study underscores the need for careful selection of care-dependent stroke patients when considering EVT, given a less favorable outcome observed in this cohort. Nonetheless, EVT should not systematically be withheld in patients with preexisting disability, since prior dependency does not significantly influence outcome.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

Arnold, Marcel; Bernasconi, Corrado Angelo; Kaesmacher, Johannes; Fischer, Urs; Mosimann, Pascal John; Jung, Simon; Meinel, Thomas Raphael; Göldlin, Martina Béatrice; Heldner, Mirjam Rachel; Volbers, Bastian; Gralla, Jan and Sarikaya, Hakan

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0340-5354

Publisher:

Springer-Medizin-Verlag

Language:

English

Submitter:

Maria de Fatima Henriques Bernardo

Date Deposited:

03 Sep 2020 12:56

Last Modified:

12 Mar 2021 15:30

Publisher DOI:

10.1007/s00415-020-10172-3

PubMed ID:

32865630

Uncontrolled Keywords:

Dependency Disability Endovascular treatment Ischemic stroke Outcome

BORIS DOI:

10.7892/boris.146282

URI:

https://boris.unibe.ch/id/eprint/146282

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