Endovascular therapy improves stroke outcomes in patients with prestroke disability

In patients with prestroke disability, endovascular therapy (EVT) has a more favourable effect on stroke outcomes compared with medical management, according to a study.

The analysis included patients with acute stroke with large‐vessel occlusion who participated in the RESCUE‐Japan Registry 2 study. These patients had prestroke modified Rankin Scale scores of 2–4, occlusion of the internal carotid artery, or M1 of the middle cerebral artery.

Of the 339 patients (median age 85 years, 67 percent women, median prestroke modified Rankin Scale [pRS] score 3), 147 (43.4 percent) had internal carotid artery (ICA) occlusion and 200 (59.0 percent) had M1 occlusion. The stroke aetiology was cardioembolism in most of the patients (261, 76.9 percent).

EVT was performed in 175 (51.6 percent) patients. Compared with those who were medically managed, EVT patients were younger (p<0.01) and had a lower pRS score (p<0.01), shorter last known well (LKW) to hospital arrival interval (p<0.01), lower baseline National Institutes of Health Stroke Scale (NIHSS) scores (p<0.01), and higher white blood cell counts (p=0.01), among others.

The primary endpoint of a favourable outcome—defined as return to at least the pRS score—at 3 months occurred with significantly greater frequency in the EVT vs medical management group (28.0 percent vs 10.9 percent; p<0.01). EVT was associated with threefold greater odds of having a favourable outcome (adjusted odds ratio, 3.01, 95 percent confidence interval, 1.55–5.85).

In terms of safety, symptomatic intracranial haemorrhage rates were similar between the EVT and medical management groups (4.0 percent vs 4.3 percent, respectively; p=1.00).

The findings indicate that withholding EVT solely because of prestroke disability may be unnecessary and lower the chance at a favourable outcome.