Endovascular Therapy for Acute Ischemic Stroke in Patients With Prestroke Disability.

Item request has been placed! ×
Item request cannot be made. ×
loading   Processing Request
Read More Add to Saved list
  • Additional Information
    • Source:
      Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 101580524 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2047-9980 (Electronic) Linking ISSN: 20479980 NLM ISO Abbreviation: J Am Heart Assoc Subsets: MEDLINE
    • Publication Information:
      Original Publication: Oxford : Wiley-Blackwell
    • Subject Terms:
      Carotid Stenosis*/complications ; Carotid Stenosis*/diagnosis ; Carotid Stenosis*/physiopathology ; Endovascular Procedures*/adverse effects ; Endovascular Procedures*/methods ; Infarction, Middle Cerebral Artery*/complications ; Infarction, Middle Cerebral Artery*/diagnosis ; Infarction, Middle Cerebral Artery*/physiopathology ; Intracranial Hemorrhages*/diagnosis ; Intracranial Hemorrhages*/etiology ; Ischemic Stroke*/diagnosis ; Ischemic Stroke*/drug therapy ; Ischemic Stroke*/etiology ; Ischemic Stroke*/surgery ; Postoperative Complications*/diagnosis ; Postoperative Complications*/epidemiology ; Thrombectomy*/adverse effects ; Thrombectomy*/methods ; Tissue Plasminogen Activator*/administration & dosage ; Tissue Plasminogen Activator*/adverse effects; Aged, 80 and over ; Disability Evaluation ; Female ; Fibrinolytic Agents/administration & dosage ; Fibrinolytic Agents/adverse effects ; Functional Status ; Humans ; Japan/epidemiology ; Male ; Outcome and Process Assessment, Health Care
    • Abstract:
      Background Outcomes after stroke as a result of large-vessel occlusion in patients with prestroke disability were compared between endovascular therapy (EVT) and medical management. Methods and Results Of 2420 patients with acute stroke with large-vessel occlusion in a prospective, multicenter, nationwide registry in Japan, patients with prestroke modified Rankin Scale scores 2 to 4 with occlusion of the internal carotid artery, or M1 of the middle cerebral artery were analyzed. The primary effectiveness outcome was the favorable outcome, defined as return to at least the prestroke modified Rankin Scale score at 3 months. Safety outcomes included symptomatic intracranial hemorrhage. A total of 339 patients (237 women; median 85 [interquartile range (IQR), 79-89] years of age; median prestroke modified Rankin Scale score of 3 [IQR, 2-4]) were analyzed. EVT was performed in 175 patients (51.6%; mechanical thrombectomy, n=139). The EVT group was younger ( p <0.01) and had lower prestroke modified Rankin Scale scores ( p <0.01) than the medical management group. The favorable outcome was seen in 28.0% of the EVT group and in 10.9% of the medical management group ( p <0.01). EVT was associated with the favorable outcome (adjusted odds ratio, 3.01; 95% CI, 1.55-5.85; mixed effects multivariable model with inverse probability of treatment weighting). Symptomatic intracranial hemorrhage rates were similar between the EVT (4.0%) and medical management (4.3%) groups ( p =1.00). Conclusions Patients who underwent EVT showed better functional outcomes than those with medical management. Given proper patient selection, withholding EVT solely on the basis of prestroke disability might not offer the best chance of favorable outcome. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02419794.
    • References:
      N Engl J Med. 2018 Feb 22;378(8):708-718. (PMID: 29364767)
      Neurology. 2019 Nov 12;93(20):869-870. (PMID: 31653708)
      Neurology. 2019 Nov 12;93(20):e1834-e1843. (PMID: 31653709)
      Stroke. 2020 May;51(5):1539-1545. (PMID: 32268851)
      J Neurointerv Surg. 2019 Oct;11(10):964-969. (PMID: 30852524)
      Stroke. 2019 Apr;50(4):901-908. (PMID: 31633899)
      Lancet. 2016 Apr 23;387(10029):1723-31. (PMID: 26898852)
      Stroke. 2019 Dec;50(12):e344-e418. (PMID: 31662037)
      Stroke. 2017 Jul;48(7):1818-1826. (PMID: 28526765)
      JAMA. 1995 Oct 4;274(13):1017-25. (PMID: 7563451)
      N Engl J Med. 2015 Jun 11;372(24):2285-95. (PMID: 25882376)
      Stat Med. 2009 Nov 10;28(25):3083-107. (PMID: 19757444)
      Lancet. 2007 Jan 27;369(9558):275-82. (PMID: 17258667)
      Stroke. 2018 Oct;49(10):2406-2414. (PMID: 30355090)
      J Am Heart Assoc. 2018 Apr 25;7(9):. (PMID: 29695384)
      Stroke. 2019 Jul;50(7):1915-1918. (PMID: 31167622)
      Stroke. 1994 Nov;25(11):2220-6. (PMID: 7974549)
      N Engl J Med. 2015 Jan 1;372(1):11-20. (PMID: 25517348)
      N Engl J Med. 2015 Mar 12;372(11):1019-30. (PMID: 25671798)
      Stroke. 2002 Aug;33(8):1993-8. (PMID: 12154251)
      N Engl J Med. 2015 Mar 12;372(11):1009-18. (PMID: 25671797)
      Am J Epidemiol. 2008 Sep 15;168(6):656-64. (PMID: 18682488)
      Lancet. 2000 May 13;355(9216):1670-4. (PMID: 10905241)
      J Neurointerv Surg. 2019 Jun;11(6):545-553. (PMID: 30389899)
      N Engl J Med. 2018 Jan 4;378(1):11-21. (PMID: 29129157)
      Stat Med. 2015 Dec 10;34(28):3661-79. (PMID: 26238958)
      Curr Neurol Neurosci Rep. 2017 Sep;17(9):69. (PMID: 28744672)
      J Stroke Cerebrovasc Dis. 2013 Jul;22(5):571-600. (PMID: 23727456)
      Stroke. 2015 Feb;46(2):407-12. (PMID: 25538199)
      N Engl J Med. 2015 Jun 11;372(24):2296-306. (PMID: 25882510)
      Lancet. 1998 Oct 17;352(9136):1245-51. (PMID: 9788453)
      Stroke. 2013 Sep;44(9):2650-63. (PMID: 23920012)
      Neurol Med Chir (Tokyo). 2019 Dec 15;59(12):449-491. (PMID: 31801934)
      N Engl J Med. 2008 Sep 25;359(13):1317-29. (PMID: 18815396)
    • Contributed Indexing:
      Keywords: disability; endovascular therapy; outcome; stroke; thrombectomy
    • Molecular Sequence:
      ClinicalTrials.gov NCT02419794
    • Accession Number:
      0 (Fibrinolytic Agents)
      EC 3.4.21.68 (Tissue Plasminogen Activator)
    • Publication Date:
      Date Created: 20210721 Date Completed: 20211022 Latest Revision: 20211022
    • Publication Date:
      20231215
    • Accession Number:
      PMC8475666
    • Accession Number:
      10.1161/JAHA.121.020783
    • Accession Number:
      34284599