Mechanical Thrombectomy in Patients With Ischemic Stroke With Prestroke Disability

被引：57

作者：

Salwi, Sanjana ^{[1
]}

Cutting, Shawna ^{[2
]}

Salgado, Alan D. ^{[5
]}

Espaillat, Kiersten ^{[5
]}

Fusco, Matthew R. ^{[6
,7
]}

Froehler, Michael T.

Chitale, Rohan V. ^{[6
]}

Kirshner, Howard ^{[5
]}

Schrag, Matthew ^{[5
]}

Jasne, Adam ^{[8
]}

Burton, Tina ^{[2
]}

MacGrory, Brian ^{[2
]}

Saad, Ali ^{[2
]}

Jayaraman, Mahesh V. ^{[3
]}

Madsen, Tracy E. ^{[4
]}

Dakay, Katarina ^{[2
]}

McTaggart, Ryan ^{[3
]}

Yaghi, Shadi ^{[9
]}

Khatri, Pooja ^{[10
]}

Mistry, Akshitkumar M. ^{[6
]}

Mistry, Eva A. ^{[5
]}

机构：

[1] Vanderbilt Univ, Sch Med, Nashville, TN 37212 USA

[2] Rhode Isl Hosp, Dept Neurol, Providence, RI USA

[3] Rhode Isl Hosp, Dept Radiol, Providence, RI USA

[4] Rhode Isl Hosp, Dept Emergency Med, Providence, RI USA

[5] Vanderbilt Univ, Med Ctr, Dept Neurol, 2525 W End Ave,Suite 612, Nashville, TN 37203 USA

[6] Vanderbilt Univ, Med Ctr, Dept Neurosurg, Nashville, TN USA

[7] Vanderbilt Univ, Med Ctr, Cerebrovasc Program, Nashville, TN USA

[8] Yale Univ, Sch Med, Dept Neurol, New Haven, CT 06510 USA

[9] New York Univ Hosp, Dept Neurol, Brooklyn, NY USA

[10] Univ Cincinnati, Dept Neurol & Rehabil Med, Cincinnati, OH 45221 USA

来源：

STROKE | 2020年 / 51卷 / 05期

基金：

美国国家卫生研究院;

关键词：

American Heart Association; infarction; patient selection; stroke; thrombectomy; INTRAVENOUS THROMBOLYSIS; INTRAARTERIAL TREATMENT; COST-EFFECTIVENESS; OUTCOMES; WOMEN;

D O I：

10.1161/STROKEAHA.119.028246

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background and Purpose- We aimed to compare functional and procedural outcomes of patients with acute ischemic stroke with none-to-minimal (modified Rankin Scale [mRS] score, 0-1) and moderate (mRS score, 2-3) prestroke disability treated with mechanical thrombectomy. Methods- Consecutive adult patients undergoing mechanical thrombectomy for an anterior circulation stroke were prospectively identified at 2 comprehensive stroke centers from 2012 to 2018. Procedural and 90-day functional outcomes were compared among patients with prestroke mRS scores 0 to 1 and 2 to 3 using chi(2), logistic, and linear regression tests. Primary outcome and significant differences in secondary outcomes were adjusted for prespecified covariates. Results- Of 919 patients treated with mechanical thrombectomy, 761 were included and 259 (34%) patients had moderate prestroke disability. Ninety-day mRS score 0 to 1 or no worsening of prestroke mRS was observed in 36.7% and 26.7% of patients with no-to-minimal and moderate prestroke disability, respectively (odds ratio, 0.63 [0.45-0.88], P=0.008; adjusted odds ratio, 0.90 [0.60-1.35], P=0.6). No increase in the disability at 90 days was observed in 22.4% and 26.7%, respectively. Rate of symptomatic intracerebral hemorrhage (7.3% versus 6.2%, P=0.65), successful recanalization (86.7% versus 83.8%, P=0.33), and median length of hospital stay (5 versus 5 days, P=0.06) were not significantly different. Death by 90 days was higher in patients with moderate prestroke disability (14.3% versus 40.3%; odds ratio, 4.06 [2.82-5.86], P<0.001; adjusted odds ratio, 2.83 [1.84, 4.37], P<0.001). Conclusions- One-third of patients undergoing mechanical thrombectomy had a moderate prestroke disability. There was insufficient evidence that functional and procedural outcomes were different between patients with no-to-minimal and moderate prestroke disability. Patients with prestroke disability were more likely to die by 90 days.

引用

页码：1539 / 1545

页数：7

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