Successful thrombectomy is beneficial in patients with pre-stroke disability: Results from an international multicenter cohort study.

Humans Retrospective Studies Treatment Outcome Endovascular Procedures / methods Canada / epidemiology Stroke / surgery Thrombectomy / methods Brain Ischemia / therapy

Interventional-thrombolysis Stroke

Journal

Journal of neuroradiology = Journal de neuroradiologie

ISSN: 0150-9861

Titre abrégé: J Neuroradiol

Pays: France

ID NLM: 7705086

Informations de publication

Date de publication:
Feb 2023

Historique:

received: 20 11 2021

revised: 18 03 2022

accepted: 19 03 2022

pubmed: 29 3 2022

medline: 31 1 2023

entrez: 28 3 2022

Statut: ppublish

Résumé

Patients with pre-stroke disability, defined as a modified Rankin Scale (mRS) ≥3, were excluded from most trials of endovascular thrombectomy (EVT) for acute stroke. We sought to evaluate the prognostic factors associated with favorable outcome in stroke patients with known disability undergoing EVT, and the impact of successful reperfusion. Consecutive acute stroke patients with pre-stroke disability, undergoing EVT, were retrospectively collected between 2016 to 2019 from a Canadian cohort and a multicenter French cohort (Endovascular Treatment in Ischemic Stroke registry-ETIS). Favorable outcome was defined as an mRS equal to pre-stroke mRS. Patients achieving successful reperfusion (defined as a modified Thrombolysis in Cerebral Infarction score of 2b/3) were compared with patients without successful reperfusion to determine if successful EVT was associated with better functional outcomes. Among 6220 patients treated with EVT, 280 (4.5%) patients with a pre-stroke mRS ≥3 were included. Sixty-one patients (21.8%) had a favorable outcome and 146 (52.1%) died at 3 months. Patients with successful reperfusion had a higher proportion of favorable 90-day mRS (27.6% versus 19.6%, p = 0.025) and a lower mortality (48.3% versus 69.6%, p = 0.008) than patients without successful reperfusion. After adjusting for baseline prognostic factors, successful reperfusion defined by TICI ≥2b was associated with favorable functional outcome (OR 3.16 CI95% [1.11-11.5]; p 0.048). In patients with pre-stroke disability, successful reperfusion is associated with a greater proportion of favorable outcome and lower mortality.

Sections du résumé

BACKGROUND BACKGROUND

METHODS METHODS

Consecutive acute stroke patients with pre-stroke disability, undergoing EVT, were retrospectively collected between 2016 to 2019 from a Canadian cohort and a multicenter French cohort (Endovascular Treatment in Ischemic Stroke registry-ETIS). Favorable outcome was defined as an mRS equal to pre-stroke mRS. Patients achieving successful reperfusion (defined as a modified Thrombolysis in Cerebral Infarction score of 2b/3) were compared with patients without successful reperfusion to determine if successful EVT was associated with better functional outcomes.

RESULTS RESULTS

Among 6220 patients treated with EVT, 280 (4.5%) patients with a pre-stroke mRS ≥3 were included. Sixty-one patients (21.8%) had a favorable outcome and 146 (52.1%) died at 3 months. Patients with successful reperfusion had a higher proportion of favorable 90-day mRS (27.6% versus 19.6%, p = 0.025) and a lower mortality (48.3% versus 69.6%, p = 0.008) than patients without successful reperfusion. After adjusting for baseline prognostic factors, successful reperfusion defined by TICI ≥2b was associated with favorable functional outcome (OR 3.16 CI95% [1.11-11.5]; p 0.048).

CONCLUSION CONCLUSIONS

In patients with pre-stroke disability, successful reperfusion is associated with a greater proportion of favorable outcome and lower mortality.

Identifiants

DOI: 10.1016/j.neurad.2022.03.006 PMID: 35341899

pubmed: 35341899

pii: S0150-9861(22)00102-X

doi: 10.1016/j.neurad.2022.03.006

pii:

doi:

Types de publication

Multicenter Study Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

59-64

Investigateurs

Michel Piotin (M)

Raphael Blanc (R)

Hocine Redjem Simon Escalard (HRS)

Jean-Philippe Desilles (JP)

François Delvoye (F)

Stanislas Smajda (S)

Benjamin Maier (B)

Solène Hebert (S)

Mikael Mazighi (M)

Mikael Obadia (M)

Candice Sabben (C)

Pierre Seners (P)

Igor Raynouard (I)

Ovide Corabianu (O)

Thomas de Broucker (T)

Eric Manchon (E)

Guillaume Taylor (G)

Malek Ben Maacha (M)

Laurie-Anne Thion (LA)

Augustin Lecler (A)

Julien Savatovsky (J)

Adrien Wang (A)

Serge Evrard (S)

Maya Tchikviladze (M)

Nadia Ajili (N)

Bertrand Lapergue (B)

David Weisenburger-Lile (D)

Lucas Gorza (L)

Géraldine Buard (G)

Oguzhan Coskun (O)

Arturo Consoli (A)

Federico Di Maria (F)

Georges Rodesh (G)

Sergio Zimatore (S)

Morgan Leguen (M)

Julie Gratieux (J)

Fernando Pico (F)

Haja Rakotoharinandrasana (H)

Philippe Tassan (P)

Roxanna Poll (R)

Sylvie Marinier (S)

Norbert Nighoghossian (N)

Roberto Riva (R)

Omer Eker (O)

Francis Turjman (F)

Laurent Derex (L)

Tae-Hee Cho (TH)

Laura Mechtouff (L)

Anne Claire Lukaszewicz (AC)

Frédéric Philippeau (F)

Serkan Cakmak (S)

Karine Blanc-Lasserre (K)

Anne-Evelyne Vallet (AE)

Gaultier Marnat (G)

Florent Gariel (F)

Xavier Barreau (X)

Jérôme Berge (J)

Patrice Menegon (P)

Igor Sibon (I)

Ludovic Lucas (L)

Stéphane Olindo (S)

Pauline Renou (P)

Sharmila Sagnier (S)

Mathilde Poli (M)

Sabrina Debruxelles (S)

François Rouanet (F)

Thomas Tourdias (T)

Jean-Sebastien Liegey (JS)

Pierre Briau (P)

Nicolas Pangon (N)

Romain Bourcier (R)

Lili Detraz (L)

Benjamin Daumas-Duport (B)

Pierre-Louis Alexandre (PL)

Monica Roy (M)

Cédric Lenoble (C)

Hubert Desal (H)

Benoît Guillon (B)

Solène de Gaalon (S)

Cécile Preterre (C)

Benjamin Gory (B)

Serge Bracard (S)

René Anxionnat (R)

Marc Braun (M)

Anne-Laure Derelle (AL)

Romain Tonnelet (R)

Liang Liao (L)

François Zhu (F)

Emmanuelle Schmitt (E)

Sophie Planel (S)

Sébastien Richard (S)

Lisa Humbertjean (L)

Gioia Mione (G)

Jean-Christophe Lacour (JC)

Nolwenn Riou-Comte (N)

Gérard Audibert (G)

Marcela Voicu (M)

Ionel Alb (I)

Marie Reitter (M)

Madalina Brezeanu (M)

Agnès Masson (A)

Adriana Tabarna (A)

Iona Podar (I)

Francisco Macian-Montoro (F)

Suzanna Saleme (S)

Charbel Mounayer (C)

Aymeric Rouchaud (A)

Vincent Costalat (V)

Caroline Arquizan (C)

Cyril Dargazanli (C)

Grégory Gascou (G)

Pierre-Henri Lefèvre (PH)

Imad Derraz (I)

Carlos Riquelme (C)

Nicolas Gaillard (N)

Isabelle Mourand (I)

Lucas Corti (L)

Federico Cagnazzo (F)

Adrien Ter Schiphorst (A)

Eugene Francois (E)

Stéphane Vannier (S)

Jean-Christophe Ferre (JC)

Helene Raoult (H)

Thomas Ronziere (T)

Maria Lassale (M)

Christophe Paya (C)

Jean-Yves Gauvrit (JY)

Clément Tracol (C)

Sophie Langnier-Lemercier (S)

Yves Samson (Y)

Charlotte Rosso (C)

Anne Leger (A)

Sandrine Deltour (S)

Frederic Clarencon (F)

Eimad Shotar (E)

Laurent Spelle (L)

Christian Denier (C)

Olivier Chassin (O)

Vanessa Chalumeau (V)

Jildaz Caroff (J)

Olivier Chassin (O)

Laura Venditti (L)

Olivier Naggara (O)

Wagih Ben Hassen (WB)

Grégoire Boulouis (G)

Christine Rodriguez-Régent (C)

Denis Trystram (D)

Basile Kerleroux (B)

Guillaume Turc (G)

Valérie Domigo (V)

Catherine Lamy (C)

Julia Birchenall (J)

Clothilde Isabel (C)

François Lun (F)

Alain Viguier (A)

Christophe Cognard (C)

Anne Christine Januel (AC)

Jean-Marc Olivot (JM)

Nicolas Raposo (N)

Fabrice Bonneville (F)

Jean François Albucher (JF)

Lionel Calviere (L)

Jean Darcourt (J)

Philippe Tall (P)

Guillaume Bellanger (G)

Louis Fontaine (L)

Emmanuel Touze (E)

Charlotte Barbier (C)

Romain Schneckenburger (R)

Marion Boulanger (M)

Julien Cogez (J)

Sophie Guettier (S)

Serge Timsit (S)

Jean-Christophe Gentric (JC)

Julien Ognard (J)

Francois Mathias Merrien (FM)

Ozlem Ozkul Wermester (OO)

Evelyne Massardier (E)

Chrysanthi Papagiannaki (C)

Frédéric Bourdain (F)

Patricia Bernady (P)

Laurent Lagoarde-Segot (L)

Hélène Cailliez (H)

Louis Veunac (L)

David Higue (D)

Valérie Wolff (V)

Raoul Pop (R)

Rémi Beaujeux (R)

Mihoc Dan-Sorin (M)

Monica Manisor (M)

Anthony Le Bras (A)

Sarah Evain (S)

Arnaud Le Guen (A)

Sebastian Richter (S)

Regis Hubrecht (R)

Stéphanie Demasles (S)

Bruno Barroso (B)

Denis Sablot (D)

Geoffroy Farouil (G)

Maxime Tardieu (M)

Philippe Smadja (P)

Sabine Aptel (S)

Ian Seiler (I)

Informations de copyright

Déclaration de conflit d'intérêts

Declaration of Competing Interest Authors declare no conflicts of interests.