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Original research
Temporal progression of functional independence after mechanical thrombectomy in acute vertebrobasilar artery occlusions
  1. Yingjie Xu1,
  2. Pan Zhang2,
  3. Wei Li3,
  4. Jinjing Wang4,
  5. Lulu Xiao5,
  6. Xianjun Huang6,
  7. Zuowei Duan7,
  8. Yongkun Li8,
  9. Feng Peng9,
  10. Feng Zhang10,
  11. Genpei Luo11,
  12. Wen Sun10
  1. 1 The First Affiliated Hospital of USTC, Hefei, China
  2. 2 The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China Department of Life Sciences and Medicine, Hefei, China
  3. 3 The First Affiliated Hospital of Hainan Medical University, Haikou, China
  4. 4 Department of Neurology, Medical School of Nanjing University, Nanjing, China
  5. 5 Jinling Hospital, Nanjing Medical University, Nanjing, China
  6. 6 Department of Neurology, The First Affiliated Hospital, Yijishan Hospital of Wannan Medical College, Wuhu, China
  7. 7 Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
  8. 8 Department of Neurology, Fujian Provincial Hospital, Fuzhou, China
  9. 9 Neurology, Zhongshan Hospital Xiamen University, Xiamen, China
  10. 10 Department of Neurology, University of Science and Technology of China, Hefei, China
  11. 11 Department of Neurology, The Tenth Affiliated Hospital of Southern Medical University, Dongguan, China
  1. Correspondence to Dr Wen Sun; sunwen_medneuro{at}163.com; Dr Genpei Luo; 13412332332{at}163.com

Abstract

Background Neurological recovery after endovascular treatment (EVT) for large vessel occlusion stroke often has diverse timelines. Understanding the temporal progression of functional independence after EVT, especially delayed functional independence (DFI) and highly delayed functional independence (HDFI), in patients who do not improve early is essential for prognostication and rehabilitation. We aimed to analyze the prevalence and predictors of DFI and HDFI after EVT in acute vertebrobasilar artery occlusions (VBAO).

Methods Patients with VBAO who received EVT in China were retrospectively enrolled. Early functional independence (EFI) was defined as a modified Rankin Scale (mRS) score of 0–2 at discharge. The incidence and predictors of DFI (mRS score 0–2 at 90 days in non-EFI patients) and HDFI (mRS score 0–2 at 1 year in non-DFI patients) were analyzed.

Results 2422 patients met the study criteria. EFI was observed in 20% (483) of patients. Among non-EFI patients, DFI was observed in 21% (395/1880). HDFI was observed in 13% (191/1439) of non-DFI patients. Younger age (P=0.006), lower pre-EVT National Institutes of Health Stroke Scale (NIHSS) score (P<0.001), higher posterior circulation-Alberta Stroke Program Early CT Score (PC-ASPECTS) (P=0.012), and absence of symptomatic intracranial hemorrhage (sICH) (P<0.001) were predictors of DFI. Predictors of HDFI were younger age (P<0.001) and lower pre-EVT NIHSS score (P<0.001).

Conclusion A considerable proportion of patients have DFI and HDFI. The independent predictors of DFI were younger age, lower pre-EVT NIHSS score, higher PC-ASPECTS, and absence of sICH. Predictors of HDFI included younger age and lower pre-EVT NIHSS score.

  • Thrombectomy
  • Stroke

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • YX and PZ contributed equally.

  • Contributors The study was conceived by YX, PZ, GL, and WS. YX and PZ prepared the initial draft of the manuscript. YX and PZ carried out the statistical analysis. GL and WS revised the manuscript. WS is responsible for the overall content as a guarantor. All authors participated in the data collection, analysis, and interpretation. The final version of the manuscript was reviewed and approved by all authors.

  • Funding The study was supported by grants from Key Research and Development Plan Projects of Anhui Province (No 202104j07020049) and Natural Science Foundation of Anhui Province (No 2108085MH271).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.