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Vascular neurology
Outcomes and safety of endovascular treatment from 6 to 24 hours in patients with a pre-stroke moderate disability (mRS 3): a multicenter retrospective study
  1. Ilaria Maestrini1,
  2. Lorenzo Rocchi2,
  3. Francesco Diana3,4,
  4. Manuel Requena Ruiz4,5,
  5. Iker Elosua-Bayes4,5,
  6. Marc Ribo4,5,
  7. Mohamad Abdalkader6,
  8. Piers Klein6,
  9. Joseph D Gabrieli7,
  10. Andrea M Alexandre8,
  11. Alessandro Pedicelli8,9,
  12. Giordano Lacidogna1,
  13. Ilaria Ciullo1,
  14. Gaultier Marnat10,
  15. Giacomo Cester7,
  16. Aldobrando Broccolini11,
  17. Thanh N Nguyen6,
  18. Alejandro Tomasello3,4,
  19. Francesco Garaci12,
  20. Marina Diomedi1,
  21. Valerio Da Ros12
    1. 1Stroke Center, Department of Systems Medicine, University Hospital of Rome Tor Vergata, Rome, Italy
    2. 2Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
    3. 3Interventional Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
    4. 4Stroke Research group, Vall d'Hebron Research Institute, Barcelona, Spain
    5. 5Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
    6. 6Diagnostic and Interventional Neuroradiology, Boston Medical Center, Boston, Massachusetts, USA
    7. 7Department of Neuroradiology, University Hospital of Padova, Padua, Italy
    8. 8UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy
    9. 9Catholic University School of Medicine, Institute of Bio-Imaging, Rome, Italy
    10. 10Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
    11. 11Neurology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
    12. 12Neuroradiology Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
    1. Correspondence to Dr Ilaria Maestrini, Stroke Center, Department of Systems Medicine, University Hospital of Rome Tor Vergata, Rome 00133, Italy; ilamaestrini{at}hotmail.com

    Abstract

    Background Approximately 30% of patients presenting with acute ischemic stroke (AIS) due to large vessel occlusion have pre-stroke modified Rankin Scale (mRS) scores ≥2. We aimed to investigate the safety and outcomes of endovascular treatment (EVT) in patients with AIS with moderate pre-stroke disability (mRS score 3) in an extended time frame (ie, 6–24 hours from the last time known well).

    Methods Data were collected from five centers in Europe and the USA from January 2018 to January 2023 and included 180 patients who underwent EVT in an extended time frame. Patients were divided into two groups of 90 each (Group 1: pre-mRS 0–2; Group 2: pre-mRS 3; 71% women, mean age 80.3±11.9 years). Primary outcomes were: (1) 3-month good clinical outcome (Group 1: mRS 0–2, Group 2: mRS 0–3) and ΔmRS; (2) any hemorrhagic transformation (HT); and (3) symptomatic HT. Secondary outcomes were successful and complete recanalization after EVT and 3-month mortality.

    Results No between-group differences were found in the 3-month good clinical outcome (26.6% vs 25.5%, P=0.974), any HT (26.6% vs 22%, P=0.733), and symptomatic HT (8.9 vs 4.4%, P=0.232). Unexpectedly, ΔmRS was significantly smaller in Group 2 compared with Group 1 (1.64±1.61 vs 2.97±1.69, P<0.001). No between-group differences were found in secondary outcomes.

    Conclusion Patients with pre-stroke mRS 3 are likely to have similar outcomes after EVT in the extended time frame to those with pre-stroke mRS 0–2, with no difference in safety.

    • Stroke
    • Thrombectomy

    Data availability statement

    Data are available upon reasonable request. Data are available upon reasonable request to the corresponding author.

    https://doi.org/10.1136/jnis-2024-021634

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      Data availability statement

      Data are available upon reasonable request. Data are available upon reasonable request to the corresponding author.

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      Footnotes

      • X @marcriboj, @PiersKlein, @NguyenThanhMD

      • Contributors IM and VDR researched literature and conceived the study. All authors were involved in patient recruitment and data analysis. IM and LR performed the statistical analyses and wrote the first draft of the paper. IM, LR, and VDR interpreted data. All authors reviewed and edited the manuscript and approved the final version and IM is the guarantor.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • Competing interests T.N. Nguyen discloses advisory board for Brainomix, Aruna Bio; Associate Editor of Stroke. The other authors declare that they have no conflict of interests.

      • 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.