Portal de Periódicos da CAPES

Predictors of Functional Outcome After Thrombectomy in Patients With Prestroke Disability in Clinical Practice

2021; Lippincott Williams & Wilkins; Volume: 53; Issue: 3 Linguagem: Inglês

10.1161/strokeaha.121.034960

1524-4628

Mònica Millán, Anna Ramos‐Pachón, Laura Dorado, Alejandro Bustamante, María Hernández‐Pérez, Luis Rodríguez‐Esparragoza, Meritxell Gomis, Sebastián Remollo, Carlos Castaño, Mariano Werner, Denisse Wenger, Sara Rubio‐Guerra, Manuel Domínguez-Lizarbe, Mikel Terceño, Andrés Paipa, Alejandro Rodríguez-Vázquez, Sandra Boned, Pol Camps‐Renom, David Cánovas, Eva Giralt, Elena López‐Cancio, Antoni Dávalos, Josep Ros-Roig, Natàlia Pérez de la Ossa, Pere Cardona, Helena Quesada, Blanca Lara, Ana Nuñez Guillen, Roger Barranco, Lucía Aja, Paloma Mora, Óscar Chirife, Sònia Aixut, María Ángeles de Miquel, Antonio Martı́nez-Yélamos, Carlos A. Molina, Marta Rubiera, Jorge Pagola, David Rodríguez‐Luna, Marián Muchada, Alejandro Tomasello, Marc Ribó, Carlos Piñana, Manuel Requena, Matías Deck, Álvaro García‐Tornel, Marta Olivé‐Gadea, Noelia Rodríguez, Jesus Jueg, Ángel Chamorro, Sergio Amaro, Xabier Urra, Laura Llull, Arturo Renú, Salvatore Rudiloso, Juan Macho, Jordi Blasco, Luís San Román, Antonio López‐Rueda, Federico Zarco, Ramón Torné, R. Valero, Vı́ctor Obach, Víctor Vera, Martha Vargas, Carlos Laredo, Joan Martí‐Fàbregas, Raquel Delgado‐Mederos, Alejandro Martínez‐Domeño, Luís Prats‐Sánchez, Daniel Guisado‐Alonso, Marina Guasch‐Jiménez, Rebeca Marín Bueno, Jordi Branera-Pujol, José Pablo Martínez, Lavinia Dinia, Anna Pellisé, Xavier Ustrell, Alan Flores, Laia Seró, Joaquı́n Serena, Yolanda Silva, Saima Bashir, Víctor Vera, Alan Murillo, Jerzy Krupiński, Sonia Huertas, Jessica Molina, Georgina Figueras, Sarah Besora, Ana Rodríguez-Campello, Jaume Roquer, Ángel Ois, Elisa Cuadrado‐Godia, Jordi Jiménez‐Conde, Elío Vivas, Polo Guimaraens, Carmen García‐Rodríguez, Jordi Estela, J. Perendreu, Nicolás Romero, Roberto Eduardo Correa, Oriol Barrachina, Moisès Broggi, Manuel Gómez‐Choco, Sònia García, Maria Àngels Font Padrós, Juan José Mengual Chirife, Luis Mena Romo, Ernest Palomeras, V. Casado, Nicolau Guanyabens, Marta Álvarez, Esther Catena, José Luis Camacho Velasquez, Francisco Purroy, Gerard Mauri, Cristina García, Jessica García Alhama, Irene Bragado Trigo, Jordi Monedero, Mònica Perecaula, Luis Guillermo Casanovas, Carla Colom, Dolores Cocho, Adela Rios González, Juanjo Baiges, Josep Zaragoza, Gisela Martin, Sonia Escalante, Patricia Esteve, Iago Payo, Lidia Binela, Josep Maria Aragonés, Núria Matos, Josep Maria Soler-Insa, Natalia Más, Glòria Díaz, Margarida Vergés, Xavier Costa, Liseth Molina, M. Cruz Almendros, Marc Pérez, Ana Cabanelas, Olga Belchí, Maria Rybyeba, Miquel Barceló, Dolors Carrión, Carmen Repullo, Eduard Sanjurjo, Mercè Salvat Plana, Josep Roig, Verònica Hidalgo, Olga Fagúndez, Victòria Sala, Anabel Bocanegra Alonso, Marisol Querol, Montse Gorchs, Xavier Jiménez, Maria Àngels Mora,

Venous Thromboembolism Diagnosis and Management

Mechanical thrombectomy (MT) in ischemic stroke patients with poor prestroke conditions remains controversial. We aimed to analyze the frequency of previously disabled patients treated with MT in clinical practice, the safety and clinical response to MT of patients with preexisting disability, and the disabled patient characteristics associated with a better response to MT.We studied all consecutive patients with anterior circulation occlusion treated with MT from January 2017 to December 2019 included in the Codi Ictus Catalunya registry-a government-mandated, prospective, hospital-based data set. Prestroke disability was defined as modified Rankin Scale score 2 or 3. Functional outcome at 90 days was centrally assessed by a blinded evaluator of the Catalan Stroke Program. Favorable outcome (to return at least to prestroke modified Rankin Scale at 90 days) and safety and secondary outcomes were compared with patients without previous disability. Logistic regression analysis was used to assess the association between prestroke disability and outcomes and to identify a disabled patient profile with favorable outcome after MT.Of 2487 patients included in the study, 409 (17.1%) had prestroke disability (313 modified Rankin Scale score 2 and 96 modified Rankin Scale score 3). After adjustment for covariates, prestroke disability was not associated with a lower chance of achieving favorable outcome at 90 days (24% versus 30%; odds ratio, 0.79 [0.57-1.08]), whereas it was independently associated with a higher risk of symptomatic intracranial hemorrhage (5% versus 3%; odds ratio, 2.04 [1.11-3.72]) and long-term mortality (31% versus 18%; odds ratio, 1.74 [1.27-2.39]) compared with patients without disability. Prestroke disabled patients without diabetes, Alberta Stroke Program Early CT Score >8 and National Institutes of Health Stroke Scale score <17 showed similar safety and outcome results after MT as patients without prestroke disability.Despite a higher mortality and risk of symptomatic intracranial hemorrhage, prestroke-disabled patients return as often as independent patients to their prestroke level of function, especially those nondiabetic patients with favorable early ischemic signs profile. These data support a potential benefit of MT in patients with previous mild or moderate disability after large anterior vessel occlusion stroke.