TY - JOUR
T1 - Benefit of successful reperfusion achieved by endovascular thrombectomy for patients with ischemic stroke and moderate pre-stroke disability (mRS 3)
T2 - Results from the MR CLEAN Registry
AU - Benali, Faysal
AU - Kappelhof, Manon
AU - Ospel, Johanna
AU - Ganesh, Aravind
AU - McDonough, Rosalie V.
AU - Postma, Alida A.
AU - Goldhoorn, Robert-Jan Berend
AU - Majoie, Charles B. L. M.
AU - van den Wijngaard, Ido
AU - Lingsma, Hester F.
AU - Vos, Jan Albert
AU - van Oostenbrugge, Robert J.
AU - van Zwam, Wim H.
AU - Goyal, Mayank
N1 - Funding Information: Competing interests WHvZ: Speaker fees from Stryker, Cerenovus, NicoLab (all paid to institution). MG: consultant (Medtronic, Stryker, Mentice, Microvention), license agreement (GE Healthcare, Microvention). AG: reports membership of editorial boards of Neurology, Neurology: Clinical Practice, and Stroke; research support from the Canadian Institutes of Health Research, Canadian Cardiovascular Society, Campus Alberta Neuroscience, and Alberta Innovates; consultation fees from MD Analytics, CTC Communications Corp, MyMedicalPanel, and Atheneum; stock options from SnapDx, TheRounds.com, and Advanced Health Analytics (AHA Health Ltd); and a provisional patent application for a system for delivery of remote ischemic conditioning or other cuff-based therapies. JO: consultant (NICO.Lab). CBLM: grants from TWIN Foundation during the conduct of the study (paid to institution); grants from CVON/Dutch Heart Foundation, grants from European Commission, grants from Health Evaluation Netherlands, grants from Stryker outside the submitted work (paid to institution); and is a shareholder of Nico-lab. Patient consent for publication Not applicable. Ethics approval Not applicable. Funding Information: Funding The MR CLEAN Registry was supported by a grant from the Toegepast Wetenschappelijk Instituut voor Neuromodulatie (TWIN). Publisher Copyright: © 2023 BMJ Publishing Group. All rights reserved.
PY - 2023/5/1
Y1 - 2023/5/1
N2 - Background: Pre-stroke dependent patients (modified Rankin Scale score (mRS) ≥3) were excluded from most trials on endovascular treatment (EVT) for acute ischemic stroke (AIS) in the anterior circulation. Therefore, little evidence exists for EVT in those patients. We aimed to investigate the safety and benefit of EVT in pre-stroke patients with mRS score 3. Methods: We used data from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic stroke in the Netherlands (MR CLEAN) Registry. All patients treated with EVT for anterior circulation AIS with pre-stroke mRS 3 were included. We assessed causes for dependence and compared patients with successful reperfusion (defined as expanded Thrombolysis in Cerebral Ischemia scale (eTICI) 2b-3) to patients without successful reperfusion. We used regression analyses with pre-specified adjustments. Our primary outcome was 90-day mRS 0-3 (functional improvement or return to baseline). Results: A total of 192 patients were included, of whom 82 (43%) had eTICI <2b and 108 (56%) eTICI ≥2b. The median age was 80 years (IQR 73-87). Fifty-one of the 192 patients (27%) suffered from previous stroke and 36/192 (19%) had cardiopulmonary disease. Patients with eTICI ≥2b more often returned to their baseline functional state or improved (n=26 (26%) vs n=15 (19%); adjusted odds ratio (aOR) 2.91 (95% CI 1.08 to 7.82)) and had lower mortality rates (n=49 (49%) vs n=50 (64%); aOR 0.42 (95% CI 0.19 to 0.93)) compared with patients with eTICI <2b. Conclusions: Although patients with AIS with pre-stroke mRS 3 comprise a heterogenous group of disability causes, we observed improved outcomes when patients achieved successful reperfusion after EVT.
AB - Background: Pre-stroke dependent patients (modified Rankin Scale score (mRS) ≥3) were excluded from most trials on endovascular treatment (EVT) for acute ischemic stroke (AIS) in the anterior circulation. Therefore, little evidence exists for EVT in those patients. We aimed to investigate the safety and benefit of EVT in pre-stroke patients with mRS score 3. Methods: We used data from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic stroke in the Netherlands (MR CLEAN) Registry. All patients treated with EVT for anterior circulation AIS with pre-stroke mRS 3 were included. We assessed causes for dependence and compared patients with successful reperfusion (defined as expanded Thrombolysis in Cerebral Ischemia scale (eTICI) 2b-3) to patients without successful reperfusion. We used regression analyses with pre-specified adjustments. Our primary outcome was 90-day mRS 0-3 (functional improvement or return to baseline). Results: A total of 192 patients were included, of whom 82 (43%) had eTICI <2b and 108 (56%) eTICI ≥2b. The median age was 80 years (IQR 73-87). Fifty-one of the 192 patients (27%) suffered from previous stroke and 36/192 (19%) had cardiopulmonary disease. Patients with eTICI ≥2b more often returned to their baseline functional state or improved (n=26 (26%) vs n=15 (19%); adjusted odds ratio (aOR) 2.91 (95% CI 1.08 to 7.82)) and had lower mortality rates (n=49 (49%) vs n=50 (64%); aOR 0.42 (95% CI 0.19 to 0.93)) compared with patients with eTICI <2b. Conclusions: Although patients with AIS with pre-stroke mRS 3 comprise a heterogenous group of disability causes, we observed improved outcomes when patients achieved successful reperfusion after EVT.
KW - Brain
KW - Stroke
KW - Thrombectomy
UR - http://www.scopus.com/inward/record.url?scp=85128876873&partnerID=8YFLogxK
U2 - https://doi.org/10.1136/neurintsurg-2022-018853
DO - https://doi.org/10.1136/neurintsurg-2022-018853
M3 - Article
C2 - 35414601
SN - 1759-8478
VL - 15
SP - 433
EP - 438
JO - Journal of NeuroInterventional Surgery
JF - Journal of NeuroInterventional Surgery
IS - 5
ER -