Clinical outcome of patients with mild pre-stroke morbidity following endovascular treatment: a HERMES substudy.
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.
Published In/Presented At
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., Goyal, M., & HERMES collaborators (2022). Clinical outcome of patients with mild pre-stroke morbidity following endovascular treatment: a HERMES substudy. Journal of neurointerventional surgery, neurintsurg-2021-018428. Advance online publication. https://doi.org/10.1136/neurintsurg-2021-018428
Diagnosis | Medicine and Health Sciences | Other Analytical, Diagnostic and Therapeutic Techniques and Equipment | Radiology
Department of Radiology and Diagnostic Medical Imaging