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Journal article
Prestroke Disability and Outcome After Thrombectomy for Emergent Anterior Circulation Large Vessel Occlusion Stroke
Neurology, v 97(19), pp E1914-E1919
09 Nov 2021
PMID: 34544817
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background and Objectives To determine the impact of endovascular therapy for large vessel occlusion stroke in patients with vs those without premorbid disability. Methods We performed a post hoc analysis of the TREVO Stent-Retriever Acute Stroke (TRACK) Registry, which collected data on 634 consecutive patients with stroke treated with the Trevo device as first-line endovascular thrombectomy (EVT) at 23 centers in the United States. We included patients with internal carotid or middle cerebral (M1/M2 segment) artery occlusions, and the study exposure was patient- or caregiver-reported premorbid modified Rank Scale (mRS) score >= 2 (premorbid disability [PD]) vs premorbid mRS score of 0 to 1 (no PD [NPD]). The primary outcome was no accumulated disability, defined as no increase in 90-day mRS score from the patient's premorbid mRS score. Results Of the 634 patients in TRACK, 407 patients were included in our cohort, of whom 53 (13.0%) had PD. The primary outcome of no accumulated disability was achieved in 37.7% (20 of 53) of patients with PD and 16.7% (59 of 354) of patients with NPD (p < 0.001), while death occurred in 39.6% (21 of 53) and 14.1% (50 of 354) (p < 0.001), respectively. The adjusted odds ratio of no accumulated disability for patients with PD was 5.2 (95% confidence interval [CI] 2.4-11.4, p < 0.001) compared to patients with NPD. However, the adjusted odds ratio for death in patients with PD was 2.90 (95% CI 1.38-6.09, p = 0.005). Discussion In this study of patients with anterior circulation acute ischemic stroke treated with EVT, we found that PD was associated with a higher probability of not accumulating further disability compared to patients with NPD but also with higher probability of death. Classification of Evidence This study provides Class II evidence that in anterior circulation acute ischemic stroke treated with EVT, patients with PD compared to those without disability were more likely not to accumulate more disability but were more likely to die.
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- Title
- Prestroke Disability and Outcome After Thrombectomy for Emergent Anterior Circulation Large Vessel Occlusion Stroke
- Creators
- Adam de Havenon - From the Department of Neurology (A.d.H.), University of Utah, Salt Lake City; Department of Neurology (A.C.), University of Toledo, OH; Department of Neurology, Neurosurgery, and Radiology (R.N.), Emory University, Atlanta, GA; Department of Neurology, Neurosurgery, and Radiology (T.N.N.), Boston Medical Center, MA; California Pacific Medical Center (J.E.), San Francisco; Department of Neurointerventional Surgery (S.R.S.), Christiana Care Health System, Newark, DE; Department of Neurosurgery (E.V.), Drexel Neurosciences Institute, Philadelphia, PA; Department of Neurology (J.L.S.), University of California, Los Angeles; Department of Neurosurgery (J.M.), Mt. Sinai, New York, NY; Department of Neurology (P.K.), University of Cincinnati, OH; Department of Neurology (E.M.), Vanderbilt Medical Center, Nashville, TN; and Department of Neurology (O.O.Z.), Mercy Health-St. Vincent Medical Center, Toledo, OH. adam.dehavenon@hsc.utah.edu.Alicia Castonguay - From the Department of Neurology (A.d.H.), University of Utah, Salt Lake City; Department of Neurology (A.C.), University of Toledo, OH; Department of Neurology, Neurosurgery, and Radiology (R.N.), Emory University, Atlanta, GA; Department of Neurology, Neurosurgery, and Radiology (T.N.N.), Boston Medical Center, MA; California Pacific Medical Center (J.E.), San Francisco; Department of Neurointerventional Surgery (S.R.S.), Christiana Care Health System, Newark, DE; Department of Neurosurgery (E.V.), Drexel Neurosciences Institute, Philadelphia, PA; Department of Neurology (J.L.S.), University of California, Los Angeles; Department of Neurosurgery (J.M.), Mt. Sinai, New York, NY; Department of Neurology (P.K.), University of Cincinnati, OH; Department of Neurology (E.M.), Vanderbilt Medical Center, Nashville, TN; and Department of Neurology (O.O.Z.), Mercy Health-St. Vincent Medical Center, Toledo, OH.Raul Nogueira - From the Department of Neurology (A.d.H.), University of Utah, Salt Lake City; Department of Neurology (A.C.), University of Toledo, OH; Department of Neurology, Neurosurgery, and Radiology (R.N.), Emory University, Atlanta, GA; Department of Neurology, Neurosurgery, and Radiology (T.N.N.), Boston Medical Center, MA; California Pacific Medical Center (J.E.), San Francisco; Department of Neurointerventional Surgery (S.R.S.), Christiana Care Health System, Newark, DE; Department of Neurosurgery (E.V.), Drexel Neurosciences Institute, Philadelphia, PA; Department of Neurology (J.L.S.), University of California, Los Angeles; Department of Neurosurgery (J.M.), Mt. Sinai, New York, NY; Department of Neurology (P.K.), University of Cincinnati, OH; Department of Neurology (E.M.), Vanderbilt Medical Center, Nashville, TN; and Department of Neurology (O.O.Z.), Mercy Health-St. Vincent Medical Center, Toledo, OH.Thanh N. Nguyen - From the Department of Neurology (A.d.H.), University of Utah, Salt Lake City; Department of Neurology (A.C.), University of Toledo, OH; Department of Neurology, Neurosurgery, and Radiology (R.N.), Emory University, Atlanta, GA; Department of Neurology, Neurosurgery, and Radiology (T.N.N.), Boston Medical Center, MA; California Pacific Medical Center (J.E.), San Francisco; Department of Neurointerventional Surgery (S.R.S.), Christiana Care Health System, Newark, DE; Department of Neurosurgery (E.V.), Drexel Neurosciences Institute, Philadelphia, PA; Department of Neurology (J.L.S.), University of California, Los Angeles; Department of Neurosurgery (J.M.), Mt. Sinai, New York, NY; Department of Neurology (P.K.), University of Cincinnati, OH; Department of Neurology (E.M.), Vanderbilt Medical Center, Nashville, TN; and Department of Neurology (O.O.Z.), Mercy Health-St. Vincent Medical Center, Toledo, OH.Joey English - From the Department of Neurology (A.d.H.), University of Utah, Salt Lake City; Department of Neurology (A.C.), University of Toledo, OH; Department of Neurology, Neurosurgery, and Radiology (R.N.), Emory University, Atlanta, GA; Department of Neurology, Neurosurgery, and Radiology (T.N.N.), Boston Medical Center, MA; California Pacific Medical Center (J.E.), San Francisco; Department of Neurointerventional Surgery (S.R.S.), Christiana Care Health System, Newark, DE; Department of Neurosurgery (E.V.), Drexel Neurosciences Institute, Philadelphia, PA; Department of Neurology (J.L.S.), University of California, Los Angeles; Department of Neurosurgery (J.M.), Mt. Sinai, New York, NY; Department of Neurology (P.K.), University of Cincinnati, OH; Department of Neurology (E.M.), Vanderbilt Medical Center, Nashville, TN; and Department of Neurology (O.O.Z.), Mercy Health-St. Vincent Medical Center, Toledo, OH.Sudhakar Reddy Satti - From the Department of Neurology (A.d.H.), University of Utah, Salt Lake City; Department of Neurology (A.C.), University of Toledo, OH; Department of Neurology, Neurosurgery, and Radiology (R.N.), Emory University, Atlanta, GA; Department of Neurology, Neurosurgery, and Radiology (T.N.N.), Boston Medical Center, MA; California Pacific Medical Center (J.E.), San Francisco; Department of Neurointerventional Surgery (S.R.S.), Christiana Care Health System, Newark, DE; Department of Neurosurgery (E.V.), Drexel Neurosciences Institute, Philadelphia, PA; Department of Neurology (J.L.S.), University of California, Los Angeles; Department of Neurosurgery (J.M.), Mt. Sinai, New York, NY; Department of Neurology (P.K.), University of Cincinnati, OH; Department of Neurology (E.M.), Vanderbilt Medical Center, Nashville, TN; and Department of Neurology (O.O.Z.), Mercy Health-St. Vincent Medical Center, Toledo, OH.Erol Veznedaroglu - University of ToledoJeffrey L. Saver - From the Department of Neurology (A.d.H.), University of Utah, Salt Lake City; Department of Neurology (A.C.), University of Toledo, OH; Department of Neurology, Neurosurgery, and Radiology (R.N.), Emory University, Atlanta, GA; Department of Neurology, Neurosurgery, and Radiology (T.N.N.), Boston Medical Center, MA; California Pacific Medical Center (J.E.), San Francisco; Department of Neurointerventional Surgery (S.R.S.), Christiana Care Health System, Newark, DE; Department of Neurosurgery (E.V.), Drexel Neurosciences Institute, Philadelphia, PA; Department of Neurology (J.L.S.), University of California, Los Angeles; Department of Neurosurgery (J.M.), Mt. Sinai, New York, NY; Department of Neurology (P.K.), University of Cincinnati, OH; Department of Neurology (E.M.), Vanderbilt Medical Center, Nashville, TN; and Department of Neurology (O.O.Z.), Mercy Health-St. Vincent Medical Center, Toledo, OH.J. Mocco - From the Department of Neurology (A.d.H.), University of Utah, Salt Lake City; Department of Neurology (A.C.), University of Toledo, OH; Department of Neurology, Neurosurgery, and Radiology (R.N.), Emory University, Atlanta, GA; Department of Neurology, Neurosurgery, and Radiology (T.N.N.), Boston Medical Center, MA; California Pacific Medical Center (J.E.), San Francisco; Department of Neurointerventional Surgery (S.R.S.), Christiana Care Health System, Newark, DE; Department of Neurosurgery (E.V.), Drexel Neurosciences Institute, Philadelphia, PA; Department of Neurology (J.L.S.), University of California, Los Angeles; Department of Neurosurgery (J.M.), Mt. Sinai, New York, NY; Department of Neurology (P.K.), University of Cincinnati, OH; Department of Neurology (E.M.), Vanderbilt Medical Center, Nashville, TN; and Department of Neurology (O.O.Z.), Mercy Health-St. Vincent Medical Center, Toledo, OH.Pooja Khatri - From the Department of Neurology (A.d.H.), University of Utah, Salt Lake City; Department of Neurology (A.C.), University of Toledo, OH; Department of Neurology, Neurosurgery, and Radiology (R.N.), Emory University, Atlanta, GA; Department of Neurology, Neurosurgery, and Radiology (T.N.N.), Boston Medical Center, MA; California Pacific Medical Center (J.E.), San Francisco; Department of Neurointerventional Surgery (S.R.S.), Christiana Care Health System, Newark, DE; Department of Neurosurgery (E.V.), Drexel Neurosciences Institute, Philadelphia, PA; Department of Neurology (J.L.S.), University of California, Los Angeles; Department of Neurosurgery (J.M.), Mt. Sinai, New York, NY; Department of Neurology (P.K.), University of Cincinnati, OH; Department of Neurology (E.M.), Vanderbilt Medical Center, Nashville, TN; and Department of Neurology (O.O.Z.), Mercy Health-St. Vincent Medical Center, Toledo, OH.Eva Mistry - From the Department of Neurology (A.d.H.), University of Utah, Salt Lake City; Department of Neurology (A.C.), University of Toledo, OH; Department of Neurology, Neurosurgery, and Radiology (R.N.), Emory University, Atlanta, GA; Department of Neurology, Neurosurgery, and Radiology (T.N.N.), Boston Medical Center, MA; California Pacific Medical Center (J.E.), San Francisco; Department of Neurointerventional Surgery (S.R.S.), Christiana Care Health System, Newark, DE; Department of Neurosurgery (E.V.), Drexel Neurosciences Institute, Philadelphia, PA; Department of Neurology (J.L.S.), University of California, Los Angeles; Department of Neurosurgery (J.M.), Mt. Sinai, New York, NY; Department of Neurology (P.K.), University of Cincinnati, OH; Department of Neurology (E.M.), Vanderbilt Medical Center, Nashville, TN; and Department of Neurology (O.O.Z.), Mercy Health-St. Vincent Medical Center, Toledo, OH.Osama O. Zaidat - From the Department of Neurology (A.d.H.), University of Utah, Salt Lake City; Department of Neurology (A.C.), University of Toledo, OH; Department of Neurology, Neurosurgery, and Radiology (R.N.), Emory University, Atlanta, GA; Department of Neurology, Neurosurgery, and Radiology (T.N.N.), Boston Medical Center, MA; California Pacific Medical Center (J.E.), San Francisco; Department of Neurointerventional Surgery (S.R.S.), Christiana Care Health System, Newark, DE; Department of Neurosurgery (E.V.), Drexel Neurosciences Institute, Philadelphia, PA; Department of Neurology (J.L.S.), University of California, Los Angeles; Department of Neurosurgery (J.M.), Mt. Sinai, New York, NY; Department of Neurology (P.K.), University of Cincinnati, OH; Department of Neurology (E.M.), Vanderbilt Medical Center, Nashville, TN; and Department of Neurology (O.O.Z.), Mercy Health-St. Vincent Medical Center, Toledo, OH.
- Publication Details
- Neurology, v 97(19), pp E1914-E1919
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 6
- Grant note
- K23NS105924 / NIH-NINDS; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Neurological Disorders & Stroke (NINDS)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Neurosurgery
- Web of Science ID
- WOS:000713678100020
- Scopus ID
- 2-s2.0-85121945061
- Other Identifier
- 991019168502304721
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