Andrea Naldi, Federico D'Agata, Giovanni Pracucci, Valentina Saia, Roberto Cavallo, Davide Castellano, Fabrizio Sallustio, Ilaria Casetta, Enrico Fainardi, Valerio Da Ros, Ilaria Maestrini, Sergio Lucio Vinci, Paolino La Spina, Nicola Limbucci, Patrizia Nencini, Elvis Lafe, Marco Longoni, Sandra Bracco, Rossana Tassi, Stefano Vallone, Guido Bigliardi, Paolo Cerrato, Lucio Castellan, Massimo Del Sette, Roberto Menozzi, Alessandro Pezzini, Stefano Merolla, Stefano Forlivesi, Sergio Nappini, Nicola Davide Loizzo, Andrea Saletti, Cristiano Azzini, Guido Andrea Lazzarotti, Nicola Giannini, Daniele Giuseppe Romano, Rosa Napoletano, Nicola Burdi, Giovanni Boero, Alessio Comai, Elisa Dall'Ora, Nicola Cavasin, Adriana Critelli, Mauro Plebani, Manuel Cappellari, Domenico Sergio Zimatore, Marco Petruzzellis, Francesco Biraschi, Ettore Nicolini, Antioco Sanna, Tiziana Tassinari, Edoardo Puglielli, Alfonsina Casalena, Ivan Gallesio, Delfina Ferrandi, Pietro Filauri, Simona Sacco, Adriana Paladini, Annalisa Rizzo, Michele Besana, Alessia Giossi, Marco Pavia, Paolo Invernizzi, Pietro Amistà, Monia Russo, Marco Filizzolo, Marina Mannino, Gianluca Galvano, Eleonora Lidia Saracco, Mauro Bergui, Salvatore Mangiafico, Danilo Toni
{"title":"Mechanical Thrombectomy in Prestroke Disability: Data From the Italian Endovascular Stroke Registry.","authors":"Andrea Naldi, Federico D'Agata, Giovanni Pracucci, Valentina Saia, Roberto Cavallo, Davide Castellano, Fabrizio Sallustio, Ilaria Casetta, Enrico Fainardi, Valerio Da Ros, Ilaria Maestrini, Sergio Lucio Vinci, Paolino La Spina, Nicola Limbucci, Patrizia Nencini, Elvis Lafe, Marco Longoni, Sandra Bracco, Rossana Tassi, Stefano Vallone, Guido Bigliardi, Paolo Cerrato, Lucio Castellan, Massimo Del Sette, Roberto Menozzi, Alessandro Pezzini, Stefano Merolla, Stefano Forlivesi, Sergio Nappini, Nicola Davide Loizzo, Andrea Saletti, Cristiano Azzini, Guido Andrea Lazzarotti, Nicola Giannini, Daniele Giuseppe Romano, Rosa Napoletano, Nicola Burdi, Giovanni Boero, Alessio Comai, Elisa Dall'Ora, Nicola Cavasin, Adriana Critelli, Mauro Plebani, Manuel Cappellari, Domenico Sergio Zimatore, Marco Petruzzellis, Francesco Biraschi, Ettore Nicolini, Antioco Sanna, Tiziana Tassinari, Edoardo Puglielli, Alfonsina Casalena, Ivan Gallesio, Delfina Ferrandi, Pietro Filauri, Simona Sacco, Adriana Paladini, Annalisa Rizzo, Michele Besana, Alessia Giossi, Marco Pavia, Paolo Invernizzi, Pietro Amistà, Monia Russo, Marco Filizzolo, Marina Mannino, Gianluca Galvano, Eleonora Lidia Saracco, Mauro Bergui, Salvatore Mangiafico, Danilo Toni","doi":"10.1161/STROKEAHA.124.048997","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The benefits and safety of mechanical thrombectomy (MT) in patients with prestroke disability, classified as modified Rankin Scale (mRS) score of 3 to 4, and anterior circulation stroke remain uncertain. This study aims to evaluate these factors using data from the Italian Registry of Endovascular Treatment in Acute Stroke.</p><p><strong>Methods: </strong>We analyzed data collected between 2015 and 2021, comparing functional outcomes (mRS), symptomatic intracerebral hemorrhage, and recanalization rates (Thrombolysis in Cerebral Infarction) at 90 days post-MT in patients with prestroke mRS score of 3 to 4 versus 0 to 2. A good outcome was defined as no change in the mRS score from baseline. Subgroup analysis was stratified by age.</p><p><strong>Results: </strong>A total of 11.411 (96%) patients with prestroke mRS score of 0 to 2 and 477 (4%) patients with prestroke mRS score of 3 to 4 were included. Compared with patients with a baseline mRS score 0 to 2, those with mRS score 3 to 4 were older (82 versus 75 years; <i>P</i><0.001) and predominantly female (71.7% versus 53%; <i>P</i><0.001). The maintenance of the same mRS score after MT was observed in 100 (23.3%) patients with prestroke mRS score 3 to 4, compared with 2332 (22.1%) patients with mRS score 0 to 2 (<i>P</i>=0.556). Mortality was significantly higher in the mRS score 3 to 4 group (n=159 [37.1%] versus n=1939 [18.4%]; <i>P</i><0.001). Successful recanalization (Thrombolysis in Cerebral Infarction score ≥2b) was lower in the mRS score 3 to 4 group (n=333 [71.6%] versus n=8706 [77.7%]; <i>P</i>=0.002), while no significant differences in symptomatic intracerebral hemorrhage were found. The benefit of MT was maintained in patients aged 80 to 85 and over 85 years with prestroke mRS score 3 to 4, although mortality remained higher.</p><p><strong>Conclusions: </strong>Our data suggest that prestroke disability does not imply less chance of returning to prestroke conditions after MT, even in octogenarians, despite higher mortality and lower recanalization rate. More data are warranted to better understand the benefit of MT in this subgroup of patients.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8000,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Stroke","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/STROKEAHA.124.048997","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: The benefits and safety of mechanical thrombectomy (MT) in patients with prestroke disability, classified as modified Rankin Scale (mRS) score of 3 to 4, and anterior circulation stroke remain uncertain. This study aims to evaluate these factors using data from the Italian Registry of Endovascular Treatment in Acute Stroke.
Methods: We analyzed data collected between 2015 and 2021, comparing functional outcomes (mRS), symptomatic intracerebral hemorrhage, and recanalization rates (Thrombolysis in Cerebral Infarction) at 90 days post-MT in patients with prestroke mRS score of 3 to 4 versus 0 to 2. A good outcome was defined as no change in the mRS score from baseline. Subgroup analysis was stratified by age.
Results: A total of 11.411 (96%) patients with prestroke mRS score of 0 to 2 and 477 (4%) patients with prestroke mRS score of 3 to 4 were included. Compared with patients with a baseline mRS score 0 to 2, those with mRS score 3 to 4 were older (82 versus 75 years; P<0.001) and predominantly female (71.7% versus 53%; P<0.001). The maintenance of the same mRS score after MT was observed in 100 (23.3%) patients with prestroke mRS score 3 to 4, compared with 2332 (22.1%) patients with mRS score 0 to 2 (P=0.556). Mortality was significantly higher in the mRS score 3 to 4 group (n=159 [37.1%] versus n=1939 [18.4%]; P<0.001). Successful recanalization (Thrombolysis in Cerebral Infarction score ≥2b) was lower in the mRS score 3 to 4 group (n=333 [71.6%] versus n=8706 [77.7%]; P=0.002), while no significant differences in symptomatic intracerebral hemorrhage were found. The benefit of MT was maintained in patients aged 80 to 85 and over 85 years with prestroke mRS score 3 to 4, although mortality remained higher.
Conclusions: Our data suggest that prestroke disability does not imply less chance of returning to prestroke conditions after MT, even in octogenarians, despite higher mortality and lower recanalization rate. More data are warranted to better understand the benefit of MT in this subgroup of patients.
期刊介绍:
Stroke is a monthly publication that collates reports of clinical and basic investigation of any aspect of the cerebral circulation and its diseases. The publication covers a wide range of disciplines including anesthesiology, critical care medicine, epidemiology, internal medicine, neurology, neuro-ophthalmology, neuropathology, neuropsychology, neurosurgery, nuclear medicine, nursing, radiology, rehabilitation, speech pathology, vascular physiology, and vascular surgery.
The audience of Stroke includes neurologists, basic scientists, cardiologists, vascular surgeons, internists, interventionalists, neurosurgeons, nurses, and physiatrists.
Stroke is indexed in Biological Abstracts, BIOSIS, CAB Abstracts, Chemical Abstracts, CINAHL, Current Contents, Embase, MEDLINE, and Science Citation Index Expanded.