SAFETY, EFFECTIVENESS, AND PRACTICALITY OF ENDOVASCULAR THERAPY WITHIN THE FIRST 3 HOURS OF ACUTE ISCHEMIC STROKE ONSET

Neurosurgery ◽  
2009 ◽  
Vol 65 (5) ◽  
pp. 860-865 ◽  
Author(s):  
Marlon S. Mathews ◽  
Jitendra Sharma ◽  
Kenneth V. Snyder ◽  
Sabareesh K. Natarajan ◽  
Adnan H. Siddiqui ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ischemic Stroke ◽  
Scale Score ◽  
Endovascular Therapy ◽  
Retrieval System ◽  
Stroke Onset ◽  
Modified Rankin Scale ◽  
Nihss Score ◽  
The Mean ◽  
Ischemic Events

Abstract OBJECTIVE This study assesses the safety, effectiveness, and practicality of endovascular therapy for ischemic stroke within the first 3 hours of symptom onset. METHODS A retrospective chart review (January 2000–July 2008) was performed of 94 consecutive patients who had endovascular therapy within 3 hours after acute ischemic stroke onset. Endovascular therapy was administered in patients in whom intravenous (IV) thrombolysis failed or was contraindicated. Outcome measures analyzed were recanalization rate, intracranial hemorrhage (ICH) rate, procedural complications, modified Rankin Scale score, National Institutes of Health Stroke Scale (NIHSS) score, and mortality rate. RESULTS The study included 41 male and 53 female patients with a mean age of 68 years (age range, 13–98 years). The mean NIHSS score at the time of admission was 14.7. Eight-three patients had anterior circulation ischemic events, and 11 had posterior circulation ischemic events. The cause was determined to be arterioembolic in 21 patients (22%), cardioembolic in 45 (48%), arterial dissection in 2, left-to-right cardiac shunt in 1, and unknown in 25 (27%). Endovascular interventions included intra-arterial (IA) pharmacological thrombolysis (n = 44), mechanical thrombolysis (Merci Retrieval System, intracranial or extracranial stent, microwire) (n = 79), and intracranial or extracranial angioplasty (n = 32) in various combinations. The mean time from stroke onset to angiogram was 72 minutes. Thirteen patients received a half dose (n = 8) or full dose (n = 5) of IV thrombolysis (tissue plasminogen activator [tPA]) in conjunction with endovascular therapy. Twenty-two patients received IA or IV adjunctive glycoprotein IIb/IIIa inhibitor (eptifibatide). Partial-to-complete recanalization (Thrombolysis in Myocardial Infarction scale score of 2 or 3) was achieved in 62 of 89 of patients (70%) presenting with significant occlusion (Thrombolysis in Myocardial Infarction scale score of 0 or 1). Postprocedure symptomatic ICH occurred in 5 patients (5.3%), which was purely subarachnoid hemorrhage in 3 patients. Of these, 2 received IA tPA in conjunction with Merci Retrieval System passes; the others each received IA tPA, mechanical thrombectomy (guidewire), or extracranial angioplasty. The total mortality rate including procedural mortality, progression of disease, and other comorbidities was 26.6%. Sixteen patients (17%) were discharged home, 49 (52%) to rehabilitation, and 4 (4%) to long-term care facilities. Overall, 36.7% had a modified Rankin Scale score of 2 or less at discharge. The mean NIHSS score at discharge was 6.5, representing an overall 8-point improvement on the NIHSS. CONCLUSION Endovascular therapy within the first 3 hours of stroke symptom onset in patients in whom IV tPA therapy is contraindicated or fails is safe, effective, and practical. The risk of symptomatic ICH is low and should be viewed relative to the poor prognosis in this group of patients.

Predictors of Outcome, Complications, and Recanalization of the Solitaire Device

Neurosurgery ◽  
2015 ◽  
Vol 77 (3) ◽  
pp. 355-361 ◽  
Author(s):  
Badih Daou ◽  
Nohra Chalouhi ◽  
Robert M. Starke ◽  
Richard Dalyai ◽  
Kate Hentschel ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cerebral Infarction ◽  
Acute Ischemic Stroke ◽  
Scale Score ◽  
Univariate Analysis ◽  
Favorable Outcome ◽  
Modified Rankin Scale ◽  
Nihss Score ◽  
Flow Restoration ◽  
The Mean

Abstract BACKGROUND: The use of mechanical thrombectomy in the management of acute ischemic stroke is becoming increasingly popular. OBJECTIVE: To identify notable factors that affect outcome, revascularization, and complications in patients with acute ischemic stroke treated with the Solitaire Flow Restoration Revascularization device. METHODS: Eighty-nine patients treated with the Solitaire Flow Restoration Revascularization device (ev3/Covidien Vascular Therapies, Irvine, California) were retrospectively analyzed. Three endpoints were considered: revascularization (Thrombolysis In Cerebral Infarction), outcome (modified Rankin Scale score), and complications. Univariate analysis and multivariate logistic regression were conducted to determine significant predictors. RESULTS: The mean time from onset of symptoms to the start of intervention was 6.7 hours. The average procedure length was 58 minutes. The mean NIH Stroke Scale (NIHSS) score was 16 on arrival and 8 at discharge. Of the patients, 6.7% had a symptomatic intracerebral hemorrhage, 16.8% had fatal outcomes within 3 months post-intervention, and 81.4% had a successful recanalization. Thrombus location in the M1 segment of the middle cerebral artery was associated with successful recanalization (thrombolysis in cerebral infarction 2b/3) (P = .003). Of the patients, 56.6% had a favorable outcome (modified Rankin Scale score at 3 months: 0–2). In patients younger than 80 years of age, 66.7% had favorable outcome. Increasing age (P = .01) and NIHSS score (P = .002) were significant predictors of a poor outcome. On multivariate analysis, NIHSS score on admission (P = .05) was a predictor of complications. On univariate analysis, increasing NIHSS score from admission to 24 hours after the procedure (P = .05) and then to discharge (P = .04) was a predictor of complications. Thrombus location in the posterior circulation (P = .04) and increasing NIHSS score (P = .04) predicted mortality. CONCLUSION: The Solitaire device is safe and effective in achieving successful recanalization after acute ischemic stroke. Important factors to consider include age, NIHSS score, and location.

scholarly journals Hemodynamic Status During Endovascular Stroke Treatment: Association of Blood Pressure with Functional Outcome

2021 ◽  
Author(s):  
Min Chen ◽  
Dorothea Kronsteiner ◽  
Johannes Pfaff ◽  
Simon Schieber ◽  
Laura Jäger ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Standard Deviation ◽  
Functional Outcome ◽  
Scale Score ◽  
Endovascular Therapy ◽  
National Institutes Of Health ◽  
Modified Rankin Scale ◽  
Vessel Occlusion ◽  
Stroke Treatment ◽  
The Mean

Abstract Background Optimal blood pressure (BP) management during endovascular stroke treatment in patients with large-vessel occlusion is not well established. We aimed to investigate associations of BP during different phases of endovascular therapy with reperfusion and functional outcome. Methods We performed a post hoc analysis of a single-center prospective study that evaluated a new simplified procedural sedation standard during endovascular therapy (Keep Evaluating Protocol Simplification in Managing Periinterventional Light Sedation for Endovascular Stroke Treatment). BP during endovascular therapy in patients was managed according to protocol. Data from four different phases (baseline, pre-recanalization, post recanalization, and post intervention) were obtained, and mean BP values, as well as changes in BP between different phases and reductions in systolic BP (SBP) and mean arterial pressure (MAP) from baseline to pre-recanalization, were used as exposure variables. The main outcome was a modified Rankin Scale score of 0–2 three months after admission. Secondary outcomes were successful reperfusion and change in the National Institutes of Health Stroke Scale score after 24 h. Multivariable linear and logistic regression models were used for statistical analysis. Results Functional outcomes were analyzed in 139 patients with successful reperfusion (defined as thrombolysis in cerebral infarction grade 2b–3). The mean (standard deviation) age was 76 (10.9) years, the mean (standard deviation) National Institutes of Health Stroke Scale score was 14.3 (7.5), and 70 (43.5%) patients had a left-sided vessel occlusion. Favorable functional outcome (modified Rankin Scale score 0–2) was less likely with every 10-mm Hg increase in baseline (odds ratio [OR] 0.76, P = 0.04) and pre-recanalization (OR 0.65, P = 0.011) SBP. This was also found for baseline (OR 0.76, P = 0.05) and pre-recanalization MAP (OR 0.66, P = 0.03). The maximum Youden index in a receiver operating characteristics analysis revealed an SBP of 163 mm Hg and MAP of 117 mm Hg as discriminatory thresholds during the pre-recanalization phase to predict functional outcome. Conclusions In our protocol-based setting, intraprocedural pre-recanalization BP reductions during endovascular therapy were not associated with functional outcome. However, higher intraprocedural pre-recanalization SBP and MAP were associated with worse functional outcome. Prospective randomized controlled studies are needed to determine whether BP is a feasible treatment target for the modification of outcomes.

Safety and feasibility of intraarterial eptifibatide as a revascularization tool in acute ischemic stroke

2011 ◽  
Vol 114 (4) ◽  
pp. 1008-1013 ◽  
Author(s):  
Muhammad Zeeshan Memon ◽  
Sabareesh K. Natarajan ◽  
Jitendra Sharma ◽  
Marlon S. Mathews ◽  
Kenneth V. Snyder ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Scale Score ◽  
Intracranial Hemorrhage ◽  
National Institutes Of Health ◽  
Modified Rankin Scale ◽  
Tissue Plasminogen ◽  
Symptomatic Intracranial Hemorrhage

Object Experience with the use of platelet glycoprotein (GP) IIb–IIIa inhibitor eptifibatide in patients with ischemic stroke is limited. The authors report the off-label use of intraarterial eptifibatide during endovascular ischemic stroke revascularization procedures for reocclusion after documented recanalization or formed fresh thrombi in distal vessels that were inaccessible to endovascular devices. Methods Patients who received intraarterial eptifibatide were identified from a prospectively collected database of patients in whom endovascular revascularization for acute ischemic stroke was attempted between 2005 and 2008. Data were analyzed retrospectively. The intraarterial eptifibatide dose was a single-bolus dose of 180 μg/kg body weight. Primary outcome measures were angiographic recanalization (Thrombolysis in Myocardial Infarction Grade 2 or 3), symptomatic intracranial hemorrhage rate, overall mortality rate, and favorable 3-month modified Rankin Scale score (≤ 2). Results The study included 35 patients (mean age 62 years, range 18–85 years). The median presenting National Institutes of Health Stroke Scale score was 13. Two patients received intravenous tissue plasminogen activator before endovascular therapy. The median time from symptom onset to therapy initiation was 230 minutes (range 90–1370 minutes). Twelve patients (34%) received intraarterial tissue plasminogen activator without mechanical measures. Mechanical revascularization measures used were Merci retriever in 19 (54%), Penumbra device in 1 (3%), balloon angioplasty in 15 (43%), and stent placement in 22 (63%) patients. The mean dose of intraarterial eptifibatide was 11.6 mg (range 5–16.6 mg). Partial-to-complete recanalization (Thrombolysis in Myocardial Infarction Grade 2 or 3) was achieved in 27 patients (77%). Postprocedure intracranial hemorrhage occurred in 13 patients (37%), causing symptoms in 5 (14%). In the 5 symptomatic intracranial hemorrhage cases, all patients but one presented more than 8 hours after symptom onset and all received intraarterial recombinant tissue plasminogen activator. The median discharge National Institutes of Health Stroke Scale score was 7 (range 0–17). At 3 months postprocedure, 21 patients (60%) had a modified Rankin Scale score ≤ 2, and 8 patients (23%) had died. Conclusions Adjunctive intraarterial eptifibatide is a feasible option for salvage of reocclusion and thrombolysis of distal inaccessible thrombi during endovascular stroke revascularization. Its safety and efficacy need to be studied further in larger, multicenter, controlled studies.

Comparison of Sub-Types and Severity of Ischemic Stroke among Both Genders

2021 ◽  
Vol 15 (6) ◽  
pp. 1340-1344
Author(s):  
Q. Yusaf ◽  
A. Qayyum ◽  
E. U. Haq, Javaria ◽  
A. Yasir ◽  
H. A. Qayyum
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Case Series ◽  
Female Gender ◽  
P Value ◽  
Modified Rankin Scale ◽  
Nihss Score ◽  
Significant Difference ◽  
Female Case ◽  
The Mean

Background: It has been noted that there is an increased prevalence and serious clinical implications of stroke in women. However, local studies focused on stroke among female gender are still scarce. Aim: To find frequency of female patients with ischemic stroke and to compare the sub-types of ischemic stroke, mean NIHSS score and mean MRS scores among both genders. Methodology: This descriptive case series was conducted in indoor and outdoor department of Neurology at Mayo Hospital, Lahore for six months [Feb 6, 2018 till August 6, 2018]. After taking demographics and clinical characteristics of patients, the severity of stroke was taken using National Institute of Health Stroke Scale (NIHSS) at admission in hospital. The functional outcome was measured using Modified Rankin Scale (MRS). Subtype of acute ischemic stroke was assigned using Oxfordshire classification for acute ischemic stroke. All data was taken on a structured proforma and was entered and analyzed using SPSS version 21. Results: The mean age of cases was 53.58 ± 9.42 years with 73(60.83%) male and 47(39.17%) female cases. Among TACS, there were 15(50%) female cases whereas 9(34.6%) female case were found in PACS and 10(33.3%) female cases were found in LACS. The frequency of gender in all subtypes was statistically same in both groups, p-value > 0.05. The mean modified Rankin scale in male and female cases was 2.93 ± 1.58 and 4.30 ±1.50 respectively with significantly higher mean MMR score in females than male cases, p-value < 0.05. Conclusion: This study concludes that females make up a considerable percentage of patients with ischemic stroke. Though, no statistically significant difference could be found in terms of subtypes of ischemic stroke, the mean NIHSS score and mean MRS were statistically higher among females compared to male cases. Keywords: Stroke, subtypes, severity, ischemia, gender difference, NIHSS, MRS

scholarly journals Efficacy of Neuroprotective Drugs in Acute Ischemic Stroke: Is It Helpful?

2019 ◽  
Vol 10 (04) ◽  
pp. 576-581 ◽  
Author(s):  
Anish Mehta ◽  
Rohan Mahale ◽  
Kiran Buddaraju ◽  
Mahendra Javali ◽  
Purushottam Acharya ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Control Group ◽  
Modified Rankin Scale ◽  
Neuroprotective Agents ◽  
Single Center ◽  
Nihss Score ◽  
Beneficial Effects ◽  
Neuroprotective Drugs ◽  
The Mean

Abstract Background Out of several neuroprotective drugs (NPDs) studied in animals and humans, four NPDs (citicoline, edaravone, cerebrolysin, and minocycline) have been found to have beneficial effects in acute ischemic stroke (AIS). Objective The purpose is to evaluate the efficacy of citicoline, edaravone, minocycline, and cerebrolysin compared with placebo in patients with middle cerebral artery (MCA) territory AIS. Materials and Methods This was a prospective, single center, single-blinded, and hospital-based study. One hundred patients with MCA territory AIS with 20 patients in each group including control group were included. Barthel index (BI), National Institute of Health Stroke Scale (NIHSS) score, and modified Rankin Scale score were recorded at admission, at day 11 and after 90 days. Results The mean NIHSS score was significantly lesser at day 11 and after 90 days in citicoline, edaravone, and cerebrolysin group in comparison with placebo. Similarly, the mean BI score was significantly higher at day 11 and after 90 days in citicoline, edaravone, and cerebrolysin group in comparison with placebo. In minocycline group, there was no significant change in the NIHSS score and BI score at day 11 and after 90 days. Conclusion There was significant improvement in the functional outcome of patients with AIS involving MCA territory at 90 days receiving citicoline, edaravone, and cerebrolysin. However, minocycline did not offer the same efficacy as compared with other neuroprotective agents.

scholarly journals Endovascular Treatment of Acute Ischemic Stroke in Patients Younger than 18 Years

2021 ◽  
Author(s):  
Sibasankar Dalai ◽  
Uday Limaye ◽  
Satyarao Kolli ◽  
Mohan V. Sumedha Maturu ◽  
Randhi Venkata Narayana ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Young Patients ◽  
Major Complication ◽  
Modified Rankin Scale ◽  
Nihss Score ◽  
Arterial Recanalization ◽  
The Mean

AbstractRapid and effective revascularization is very important in the treatment of acute ischemic stroke (AIS). Endovascular treatment is a promising modality in the management of AIS in young patients. We evaluated the clinical and imaging records in 14 patients younger than 18 years presenting within 6 hours of AIS. They received endovascular therapy (ET) either by mechanical thrombectomy, thromboaspiration, or both (Solumbra) between July 2017 and June 2021 in our institute. The National Institute of Health Stroke Scale (NIHSS) score was calculated on admission and before the discharge of all patients. The 90-day modified Rankin Scale (mRS) score on disability-free outcome was also evaluated. The mean preprocedure NIHSS score was 10.78 ± 2.11 that improved to 4.5 ± 1.88 after the procedure. Thrombolysis in cerebral infarction (TICI) grade 2b and 3 blood flow could be established in 12 (85.72%) patients. One patient had TICI 2a flow and one patient had recurrent occlusion despite repeated recanalization (TICI grade 0). The disability-free outcome, mRS score at 90 days was 0 to 1 in 12 (85.72%) patients, mRS score 2 in one (7.14%) patient, and mRS score 3 in one patient (7.14%). We did not have any major complication related to the procedure. ET provides high rates of arterial recanalization and favorable disability-free outcomes in young patients with AIS.

scholarly journals A multicenter randomized controlled trial of endovascular therapy following imaging evaluation for ischemic stroke (DEFUSE 3)

2017 ◽  
Vol 12 (8) ◽  
pp. 896-905 ◽  
Author(s):  
Gregory W Albers ◽  
Maarten G Lansberg ◽  
Stephanie Kemp ◽  
Jenny P Tsai ◽  
Phil Lavori ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Primary Endpoint ◽  
Endovascular Therapy ◽  
Symptom Onset ◽  
Medical Management ◽  
Controlled Trial ◽  
Modified Rankin Scale ◽  
Computed Tomography Perfusion

Rationale Early reperfusion in patients experiencing acute ischemic stroke is effective in patients with large vessel occlusion. No randomized data are available regarding the safety and efficacy of endovascular therapy beyond 6 h from symptom onset. Aim The aim of the study is to demonstrate that, among patients with large vessel anterior circulation occlusion who have a favorable imaging profile on computed tomography perfusion or magnetic resonance imaging, endovascular therapy with a Food and Drug Administration 510 K-cleared mechanical thrombectomy device reduces the degree of disability three months post stroke. Design The study is a prospective, randomized, multicenter, phase III, adaptive, blinded endpoint, controlled trial. A maximum of 476 patients will be randomized and treated between 6 and 16 h of symptom onset. Procedures Patients undergo imaging with computed tomography perfusion or magnetic resonance diffusion/perfusion, and automated software (RAPID) determines if the Target Mismatch Profile is present. Patients who meet both clinical and imaging selection criteria are randomized 1:1 to endovascular therapy plus medical management or medical management alone. The individual endovascular therapist chooses the specific device (or devices) employed. Study outcomes The primary endpoint is the distribution of scores on the modified Rankin Scale at day 90. The secondary endpoint is the proportion of patients with modified Rankin Scale 0–2 at day 90 (indicating functional independence). Analysis Statistical analysis for the primary endpoint will be conducted using a normal approximation of the Wilcoxon–Mann–Whitney test (the generalized likelihood ratio test).

Abstract 268: Is There a Weekend Effect on Telestroke Code Time Metrics?

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Ganesh Asaithambi ◽  
Amy L Castle ◽  
Emily H Marino ◽  
Bridget M Ho ◽  
Sandra K Hanson
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Scale Score ◽  
Mortality Rates ◽  
Weekend Effect ◽  
Favorable Outcome ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Code Process

Background: It has been suggested that there is a “weekend effect” resulting in higher mortality rates for stroke patients admitted on weekends. We examine this phenomenon for acute ischemic stroke (AIS) patients presenting to telestroke (TS) sites to determine its effect on stroke code process times and outcomes. Methods: From October 2015-June 2017, we reviewed consecutive AIS patients receiving IV alteplase within our TS network who then were transferred to our CSC. We compared patients presenting to TS sites on weekdays (Monday 0700 to Friday 1859) to patients presenting on weekends (Friday 1900 to Monday 0659). We analyzed door to code activation, code activation to TS evaluation, door to imaging, and door to needle times. Rates of favorable outcome (modified Rankin Scale score ≤2) and death at 90 days were compared. Results: We identified 89 (54 weekday, 35 weekend) patients (mean age 71.8±13.3 years, 47.2% women) during the study period. Median door to code activation (15 [5, 27] vs 8 [1, 17] mins, p=0.01) and door to needle (61 [49, 73] vs 47 [35, 59] mins, p=0.003) times were significantly longer for patients presenting on weekends compared to weekdays. There were no significant differences in median door to imaging (weekend 17 [7, 30] vs weekday 11 [6, 21], p=0.1) and code activation to TS evaluation (weekend 7 [6, 10] vs weekday 5 [4, 9], p=0.14) times. The rates of favorable outcome (weekend 50% vs weekday 66.7%, p=0.18) and death (weekend 8.3% vs weekday 4.8%, p=0.56) at 90 days were not significantly different. Conclusion: While there were no significant differences in outcomes, the “weekend effect” results in slower door to code activation and door to needle times. Efforts to improve methods in increasing efficiency of care on weekends should be considered.

scholarly journals Recanalization and Angiographic Reperfusion Are Both Associated with a Favorable Clinical Outcome in the IMS III Trial

2016 ◽  
Vol 5 (3-4) ◽  
pp. 118-122 ◽  
Author(s):  
Marie L. Schmitz ◽  
Sharon D. Yeatts ◽  
Thomas A. Tomsick ◽  
David S. Liebeskind ◽  
Achala Vagal ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Scale Score ◽  
Predictive Accuracy ◽  
Favorable Outcome ◽  
Modified Rankin Scale ◽  
Arterial Tree ◽  
Stroke Treatment ◽  
Optimal Thresholds ◽  
Favorable Clinical Outcome

Background: Prompt revascularization is the main goal of acute ischemic stroke treatment. We examined which revascularization scale - reperfusion (modified Treatment in Cerebral Infarctions, mTICI) or recanalization (Arterial Occlusive Lesion, AOL) - better predicted the clinical outcome in ischemic stroke participants treated with endovascular therapy (EVT). Additionally, we determined the optimal thresholds for the predictive accuracy of each scale. Methods: We included participants from the Interventional Management of Stroke (IMS) III trial with complete occlusion in the internal carotid artery terminus or proximal middle cerebral artery (M1 or M2) who completed EVT within 7 h of symptom onset. The abilities of the AOL and mTICI scales to predict a favorable outcome (defined as a modified Rankin Scale score of 0-2 at 3 months) were compared by receiver operating characteristic analyses. The maximal sensitivity and specificity for each revascularization scale were established. Results: Among 240 participants who met the study inclusion criteria, 79 (33%) achieved a favorable outcome. Higher scores of mTICI and AOL increased the likelihood of a favorable outcome (2.7% with mTICI 0 vs. 83.3% with mTICI 3, and 3.0% with AOL 0 vs. 43% with AOL 3). The accuracy of mTICI reperfusion and AOL recanalization for a favorable outcome prediction was similar, with optimal thresholds of mTICI 2b/3 and AOL 3, respectively. Conclusion: Reperfusion (mTICI) and recanalization (AOL) predicted a favorable clinical outcome with comparable accuracy in ischemic stroke participants treated with EVT. Optimal revascularization goals to maximize clinical outcome (modified Rankin Scale score of 0-2) consisted of complete recanalization (AOL 3) and reperfusion of at least 50% of the arterial tree of the symptomatic artery (mTICI 2b/3) in the IMS III trial setting.

scholarly journals Quality of Life in Physical, Social, and Cognitive Domains Improves With Endovascular Therapy in the DEFUSE 3 Trial

Stroke ◽  
2021 ◽  
Author(s):  
Laura C. Polding ◽  
William J. Tate ◽  
Michael Mlynash ◽  
Michael P. Marks ◽  
Jeremy J. Heit ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Ischemic Stroke ◽  
Medical Therapy ◽  
Social Participation ◽  
Endovascular Therapy ◽  
Neurological Disorders ◽  
Measurement Tool ◽  
Modified Rankin Scale ◽  
Standard Medical Therapy

Background and Purpose: The DEFUSE 3 (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3) randomized clinical trial demonstrated the efficacy of endovascular therapy in treating ischemic stroke 6 to 16 hours after onset, resulting in better functional outcomes than standard medical therapy alone. The objective of this secondary analysis is to analyze the effect of late-window endovascular treatment of ischemic stroke on quality of life (QoL) outcomes. Methods: Patients (n=182) who presented between 6 and 16 hours after they were last known to be well with acute anterior circulation ischemic stroke were randomized to endovascular thrombectomy plus standard medical therapy or standard medical therapy alone and followed-up through 90 days poststroke. QoL at day 90 was assessed with the QoL in Neurological Disorders measurement tool. Results: Of the 146 subjects alive at day 90, 136 (95%) filled out QoL in Neurological Disorders short forms. Patients treated with endovascular therapy had better QoL scores in each domain: mobility, social participation, cognitive function, and depression ( P <0.01 for all). Variables other than endovascular therapy that were independently associated with better QoL included lower baseline National Institutes of Health Stroke Scale, younger age, and male sex. The degree to which the modified Rankin Scale captures differences in QoL between patients varied by domain; the modified Rankin Scale score accounted for a high proportion of the variability in mobility (Rs 2 =0.82), a moderate proportion in social participation (Rs 2 =0.62), and a low proportion in cognition (Rs 2 =0.31) and depression (Rs 2 =0.19). Conclusions: Patients treated with endovascular therapy 6 to 16 hours after stroke have better QoL than patients treated with medical therapy alone, including better mobility, more social participation, superior cognition, and less depression. The modified Rankin Scale fails to capture patients’ outcomes in cognition and depression, which should therefore be assessed with dedicated QoL tools. REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02586415.

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