Impact of pre-stroke dependency on outcome after endovascular therapy in acute ischemic stroke
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ORIGINAL COMMUNICATION
Impact of pre‑stroke dependency on outcome after endovascular therapy in acute ischemic stroke Lisa Oesch1 · Marcel Arnold1 · Corrado Bernasconi1 · Johannes Kaesmacher2,3 · Urs Fischer1 · Pascal J. Mosimann2 · Simon Jung1 · Thomas Meinel1 · Martina Goeldlin1,2 · Mirjam Heldner1 · Bastian Volbers1,4 · Jan Gralla2 · Hakan Sarikaya1 Received: 7 February 2020 / Revised: 13 July 2020 / Accepted: 17 August 2020 © The Author(s) 2020
Abstract Background and purpose Current demographic changes indicate that more people will be care-dependent due to increasing life expectancy. Little is known about impact of preexisting dependency on stroke outcome after endovascular treatment (EVT). Methods We compared prospectively collected baseline and outcome data of previously dependent vs. independent stroke patients (prestroke modified Rankin Scale score of 3–5 vs. 0–2) treated with EVT. Outcome measures were favorable 3-month outcome (mRS ≤ 3 for previously dependent and mRS ≤ 2 for independent patients, respectively), death and symptomatic intracranial hemorrhage (sICH). Results Among 1247 patients, 84 (6.7%) were dependent before stroke. They were older (81 vs. 72 years of age), more often female (61.9% vs. 46%), had a higher stroke severity at baseline (NIHSS 18 vs. 15 points), more often history of previous stroke (32.9% vs. 9.1%) and more vascular risk factors than independent patients. Favorable outcome and mortality were to the disadvantage of independent patients (26.2% vs. 44.4% and 46.4% vs. 25.5%, respectively), whereas sICH was comparable in both cohorts (4.9% vs. 5%). However, preexisting dependency was not associated with clinical outcome and mortality after adjusting for outcome predictors (OR 1.076, 95% CI 0.612–1.891; p = 0.799 and OR 1.267, 95% CI 0.758–2.119; p = 0.367, respectively). Conclusion Our study underscores the need for careful selection of care-dependent stroke patients when considering EVT, given a less favorable outcome observed in this cohort. Nonetheless, EVT should not systematically be withheld in patients with preexisting disability, since prior dependency does not significantly influence outcome. Keywords Ischemic stroke · Endovascular treatment · Dependency · Disability · Outcome
Background and purpose Jan Gralla and Hakan Sarikaya equal contribution to work. * Hakan Sarikaya [email protected] 1
Department of Neurology, Bern University Hospital, Freiburgstrasse 10, 3010 Bern, Switzerland
2
Department of Diagnostic and Interventional Neuroradiology, Bern University Hospital, Freiburgstrasse 10, 3010 Bern, Switzerland
3
Department of Diagnostic, Interventional and Pediatric Radiology, Bern University Hospital, Freiburgstrasse 10, 3010 Bern, Switzerland
4
Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
Current demographic changes indicate that an increasing number of people will need external help in their daily life, given the rising life expectancy and incidence of care dependency among older people in Western
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