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

McDonough, R. V. et al. (2022) Clinical outcome of patients with mild pre-stroke morbidity following endovascular treatment: a HERMES substudy. Journal of NeuroInterventional Surgery, (doi: 10.1136/neurintsurg-2021-018428) (PMID:35210331) (Early Online Publication)

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Abstract

Background: Analyses 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. Methods: The 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. Results: We 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). Conclusions: Patients 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.

Item Type:Articles
Status:Early Online Publication
Refereed:Yes
Glasgow Author(s) Enlighten ID:Muir, Professor Keith
Authors: 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., and Goyal, M.
Subjects:R Medicine > R Medicine (General)
College/School:College of Medical Veterinary and Life Sciences > School of Psychology & Neuroscience
Journal Name:Journal of NeuroInterventional Surgery
Publisher:BMJ Publishing Group
ISSN:1759-8478
ISSN (Online):1759-8486
Published Online:24 February 2022

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