Impact of pre-stroke dependency on outcome after endovascular therapy in acute ischemic stroke
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:268 |
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| Enthalten in: |
Journal of neurology - 268(2021), 2 vom: 31. Feb., Seite 541-548 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Oesch, Lisa [VerfasserIn] |
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| Links: |
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| Themen: |
Dependency |
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| Anmerkungen: |
Date Completed 18.06.2021 Date Revised 18.06.2021 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1007/s00415-020-10172-3 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM314387617 |
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| 245 | 1 | 0 | |a Impact of pre-stroke dependency on outcome after endovascular therapy in acute ischemic stroke |
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| 500 | |a Date Revised 18.06.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a 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) | ||
| 520 | |a 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) | ||
| 520 | |a 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) | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Dependency | |
| 650 | 4 | |a Disability | |
| 650 | 4 | |a Endovascular treatment | |
| 650 | 4 | |a Ischemic stroke | |
| 650 | 4 | |a Outcome | |
| 700 | 1 | |a Arnold, Marcel |e verfasserin |4 aut | |
| 700 | 1 | |a Bernasconi, Corrado |e verfasserin |4 aut | |
| 700 | 1 | |a Kaesmacher, Johannes |e verfasserin |4 aut | |
| 700 | 1 | |a Fischer, Urs |e verfasserin |4 aut | |
| 700 | 1 | |a Mosimann, Pascal J |e verfasserin |4 aut | |
| 700 | 1 | |a Jung, Simon |e verfasserin |4 aut | |
| 700 | 1 | |a Meinel, Thomas |e verfasserin |4 aut | |
| 700 | 1 | |a Goeldlin, Martina |e verfasserin |4 aut | |
| 700 | 1 | |a Heldner, Mirjam |e verfasserin |4 aut | |
| 700 | 1 | |a Volbers, Bastian |e verfasserin |4 aut | |
| 700 | 1 | |a Gralla, Jan |e verfasserin |4 aut | |
| 700 | 1 | |a Sarikaya, Hakan |e verfasserin |4 aut | |
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