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Endovascular therapy in acute ischaemic stroke patients with prestroke dependency-an EVA-TRISP cohort study
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Resumo(s)
INTRODUCTION: Acute EVT may be withheld from stroke patients with prestroke dependency on the help of others in daily activities because of insufficient randomised evidence. Using data from a large registry, we aimed to improve evidence for EVT decision-making in these patients. PATIENTS AND METHODS: Multicentre international observational study from the EndoVascular Therapy and ThRombolysis in Ischemic Stroke Patients (EVA-TRISP) collaboration comparing prestroke-dependent (prestroke mRS 3-4) with prestroke-independent patients (prestroke mRS 0-2). We used multivariate logistic regression analysis and report odds ratios (ORs) and 95% CIs. Outcomes were poor functional outcome in survivors (defined relative to the prestroke mRS), 3 month mortality, sICH occurrence and unsuccessful recanalisation. RESULTS: Of 13,525 eligible patients, 1436 (10.6%) were prestroke-dependent. These patients were older (median 84 vs 73 years), more often women (61.0% vs 46.7%) and had higher NIHSS score (median 16 vs 14 points). While the odds of death (ORadjusted 2.33 [95% CI, 2.04-2.66]; 48.6% vs 19.6%) and unsuccessful recanalisation (ORadjusted 1.16 [95% CI, 1.02-1.33]; 31.0% vs 26.6%) were higher in prestroke-dependent patients, there was no evidence of increased odds of poor functional outcome in survivors (ORadjusted 0.68 [95% CI, 0.57-0.81]; 42.8% vs 40.0%) and sICH (ORadjusted 0.72 [95% CI, 0.53-0.98]; 3.8% vs 4.6%). DISCUSSION AND CONCLUSIONS: Despite higher mortality and recanalisation failure, prestroke-dependent patients did not have worse functional outcomes among survivors or higher sICH risk. This suggests that EVT should not be withheld solely on the basis of prestroke dependency.
Descrição
Publisher Copyright: © The Author(s) 2026. Published by Oxford University Press on behalf of the European Stroke Organisation.
Palavras-chave
functional outcome mechanical thrombectomy success mortality mRS real-world registry sICH Clinical Neurology Cardiology and Cardiovascular Medicine