Endovascular Therapy in the Extended Time Window for Large Vessel Occlusion in Patients With Pre-Stroke Disability

Kanta Tanaka, Hiroshi Yamagami, Muhammad M. Qureshi, Kazutaka Uchida, James E. Siegler, Raul G. Nogueira, Shinichi Yoshimura, Nobuyuki Sakai, Nicolas Martinez-Majander, Simon Nagel, Jelle Demeestere, Volker Puetz, Diogo C. Haussen, Mohamad Abdalkader, Marta Olive-Gadea, Mahmoud H. Mohammaden, João Pedro Marto, Anne Dusart, Simon Winzer, Liisa TomppoFrancois Caparros, Hilde Henon, Flavio Bellante, João Nuno Ramos, Santiago Ortega-Gutierrez, Sunil A. Sheth, Stefania Nannoni, Johannes Kaesmacher, Lieselotte Vandewalle, Sergio Salazar-Marioni, Mudassir Farooqui, Pekka Virtanen, Rita Ventura, Syed Zaidi, Alicia C. Castonguay, Ajit S. Puri, Behzad Farzin, Hesham E. Masoud, Piers Klein, Jessica Jesser, Manuel Requena, Tomas Dobrocky, Daniel P.O. Kaiser, Erno Peltola, Davide Strambo, Markus A. Möhlenbruch, Eugene Lin, Peter A. Ringleb, Osama O. Zaidat, Charlotte Cordonnier, Daniel Roy, Robin Lemmens, Marc Ribo, Daniel Strbian, Urs Fischer, Patrik Michel, Jean Raymond, Thanh N. Nguyen

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Background and Purpose We compared the outcomes of endovascular therapy (EVT) in an extended time window in patients with large-vessel occlusion (LVO) between patients with and without prestroke disability. Methods In this prespecified analysis of the multinational CT for Late Endovascular Reperfusion study (66 participating sites, 10 countries between 2014 and 2022), we analyzed data from patients with acute ischemic stroke with a pre-stroke modified Rankin Scale (mRS) score of 0–4 and LVO who underwent EVT 6–24 hours from the time last seen well. The primary outcome was the composite of functional independence (FI; mRS score 0–2) or return to the pre-stroke mRS score (return of Rankin, RoR) at 90 days. Outcomes were compared between patients with pre-stroke disability (pre-stroke mRS score 2–4) and those without (mRS score 0–1). Results A total of 2,231 patients (median age, 72 years; median National Institutes of Health Stroke Scale score, 16) were included in the present analysis. Of these, 564 (25%) had pre-stroke disability. The primary outcome (FI or RoR) was observed in 30.7% of patients with pre-stroke disability (FI, 16.5%; RoR, 30.7%) compared to 44.1% of patients without (FI, 44.1%; RoR, 13.0%) (P<0.001). In multivariable logistic regression analysis with inverse probability of treatment weighting, pre-stroke disability was not associated with significantly lower odds of achieving FI or RoR (adjusted odds ratio 0.73, 95% confidence interval 0.43–1.25). Symptomatic intracranial hemorrhage occurred in 6.3% of both groups (P=0.995). Conclusion A considerable proportion of patients with late-presenting LVO and pre-stroke disability regained pre-stroke mRS scores after EVT. EVT may be appropriate for patients with pre-stroke disability presenting in the extended time window.

Original languageEnglish
JournalJournal of stroke
Volume26
Issue number2
Pages (from-to)269-279
Number of pages11
ISSN2287-6391
DOIs
Publication statusPublished - May 2024
MoE publication typeA1 Journal article-refereed

Bibliographical note

Publisher Copyright:
© 2024 Korean Stroke Society.

Fields of Science

  • Activities of daily living
  • Endovascular therapy
  • Ischemic stroke
  • Outcome
  • Reperfusion
  • 3124 Neurology and psychiatry

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