Clinical outcome of patients with mild pre-stroke morbidity following endovascular treatment: a HERMES substudy

Autor: McDonough, R.V., Ospel, J.M., Majoie, C.B.L.M., Saver, J.L., White, P., Dippel, D.W.J., Brown, S.B., Demchuk, A.M., Jovin, T.G., Mitchell, P.J., Bracard, S., Campbell, B.C.V., Muir, K.W., Hill, M.D., Guillemin, F., Goyal, M., HERMES Collaborators
Přispěvatelé: Radiology and Nuclear Medicine, ANS - Neurovascular Disorders, ACS - Microcirculation, Radiology and nuclear medicine, Neurology
Rok vydání: 2022
Předmět:
Zdroj: Journal of neurointerventional surgery. BMJ Publishing Group
Journal of NeuroInterventional Surgery, 15(3). BMJ PUBLISHING GROUP
Journal of NeuroInterventional Surgery, 15(3):018428. BMJ Publishing Group
McDonough, R V, Ospel, J M, Majoie, C B L M, Saver, J L, White, P, Dippel, D W J, Brown, S B, Demchuk, A M, Jovin, T G, Mitchell, P J, Bracard, S, Campbell, B C V, Muir, K W, Hill, M D, Guillemin, F & Goyal, M 2022, ' Clinical outcome of patients with mild pre-stroke morbidity following endovascular treatment : A HERMES substudy ', Journal of neurointerventional surgery . https://doi.org/10.1136/neurintsurg-2021-018428
ISSN: 1759-8486
1759-8478
DOI: 10.1136/neurintsurg-2021-018428
Popis: BackgroundAnalyses of the effect of pre-stroke functional levels on the outcome of endovascular therapy (EVT) have focused on the course of patients with moderate to substantial pre-stroke disability. The effect of complete freedom from pre-existing disability (modified Rankin Scale (mRS) 0) versus predominantly mild pre-existing disability/symptoms (mRS 1–2) has not been well delineated.MethodsThe HERMES meta-analysis pooled data from seven randomized trials that tested the efficacy of EVT. We tested for a multiplicative interaction effect of pre-stroke mRS on the relationship between treatment and outcomes. Ordinal regression was used to assess the association between EVT and 90-day mRS (primary outcome) in the subgroup of patients with pre-stroke mRS 1–2. Multivariable regression modeling was then used to test the effect of mild pre-stroke disability/symptoms on the primary and secondary outcomes (delta-mRS, mRS 0–2/5–6) compared with patients with pre-stroke mRS 0.ResultsWe included 1764 patients, of whom 199 (11.3%) had pre-stroke mRS 1–2. No interaction effect of pre-stroke mRS on the relationship between treatment and outcome was observed. Patients with pre-stroke mRS 1–2 had worse outcomes than those with pre-stroke mRS 0 (adjusted common OR (acOR) 0.53, 95% CI 0.40 to 0.70). Nonetheless, a significant benefit of EVT was observed within the mRS 1–2 subgroup (cOR 2.08, 95% CI 1.22 to 3.55).ConclusionsPatients asymptomatic/without disability prior to onset have better outcomes following EVT than patients with mild disability/symptoms. Patients with pre-stroke mRS 1–2, however, more often achieve good outcomes with EVT compared with conservative management. These findings indicate that mild pre-existing disability/symptoms influence patient prognosis after EVT but do not diminish the EVT treatment effect.
Databáze: OpenAIRE
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