Prestroke Disability and Outcome After Thrombectomy for Emergent Anterior Circulation Large Vessel Occlusion Stroke

It is going to be your responsibility to NOT HAVE premorbid disability. You wouldn't want to inconvience your doctors in having to be prepared for any stroke.

 

Prestroke Disability and Outcome After Thrombectomy for Emergent Anterior Circulation Large Vessel Occlusion Stroke

View ORCID ProfileAdam de Havenon, Alicia Castonguay, Raul Nogueira, Thanh N. Nguyen, Joey English, Sudhakar Reddy Satti, Erol Veznedaroglu, Jeffrey L. Saver, J Mocco, Pooja Khatri, Eva Mistry, Osama O. Zaidat

First published September 20, 2021, DOI: https://doi.org/10.1212/WNL.0000000000012827

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Abstract

Objective

To determine the impact of endovascular therapy for large vessel occlusion stroke in patients with pre-morbid disability versus those without.

Methods

We performed a post-hoc analysis of the TREVO Stent-Retriever Acute Stroke (TRACK) Registry, which collected data on 634 consecutive stroke patients treated with the Trevo device as first-line EVT at 23 centers in the United States. We included patients with internal carotid or middle cerebral (M1/M2 segment) artery occlusions and the study exposure was patient- or caregiver-reported premorbid modified Rank Scale (mRS) ≥2 (premorbid disability, PD) versus premorbid mRS score 0-1 (no premorbid disability, NPD). The primary outcome was no accumulated disability, defined as no increase in 90-day mRS from the patient’s pre-morbid mRS.

Results

Of the 634 patients in TRACK, 407 patients were included in our cohort, of which 53/407 (13.0%) had PD. The primary outcome of no accumulated disability was achieved in 37.7% (20/53) of patients with PD and 16.7% (59/354) of patients with NPD (p<0.001), while death occurred in 39.6% (21/53) and 14.1% (50/354) (p<0.001), respectively. The adjusted odds ratio of no accumulated disability for PD patients was 5.2 (95% CI 2.4-11.4, p<0.001) compared to patients with NPD. However, the adjusted odds ratio for death in PD patients was 2.90 (95% CI 1.38-6.09, p=0.005).

Conclusions

In this study of anterior circulation acute ischemic stroke patients treated with EVT, we found that premorbid disability was associated with a higher probability of not accumulating further disability compared to patients with no premorbid disability, but also with higher probability of death.

Classification of Evidence

This study provides Class II evidence that in anterior circulation acute ischemic stroke treated with EVT, patients with premorbid disability compared to those without disability were more likely not to accumulate more disability but were more likely to die.

• Received February 20, 2021.
• Accepted in final form August 27, 2021.

• © 2021 American Academy of Neurology