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Clinical Outcome of Patients with Mild Pre-Stroke Morbidity Following Endovascular Treatment: A HERMES Substudy

Abstract : 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.
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https://hal-u-picardie.archives-ouvertes.fr/hal-03719723
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Soumis le : lundi 11 juillet 2022 - 14:34:05
Dernière modification le : vendredi 5 août 2022 - 11:24:00

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Rosalie V. Mcdonough, Johanna M. Ospel, Charles B. L. M. Majoie, Jeffrey L. Saver, Philip White, et al.. Clinical Outcome of Patients with Mild Pre-Stroke Morbidity Following Endovascular Treatment: A HERMES Substudy. Journal of NeuroInterventional Surgery, 2022, pp.neurintsurg--2021--018428. ⟨10.1136/neurintsurg-2021-018428⟩. ⟨hal-03719723⟩

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