Abstract Details

Title Endovascular Treatment of Acute Ischemic Stroke in Patients with versus without Pre-morbid Disability: A Meta-analysis

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P1 - Poster Session 1 (9:00 AM-5:00 PM)

Poster/Presentation
Number 106

Objective

To examine outcomes of endovascular therapy (EVT) for acute ischemic stroke in patients with pre-stroke disability compared to those without.

Background

Trials of EVT for acute stroke have generally excluded patients with pre-morbid disability. Observational studies may help inform consideration of EVT in this population.

Design/Methods

In this meta-analysis (PROSPERO CRD42021240499, MOOSE-compliant), we searched Medline and Embase for studies describing outcomes in adults with and without pre-morbid disability (modified Rankin Scale[mRS] ≥2), treated for acute ischemic stroke and anterior circulation large vessel occlusion. Study quality was assessed using the Quality In Prognosis Studies tool. Random-effects meta-analysis was used to pool outcomes including return to baseline mRS at 90-days, favorable outcome (mRS 0-2 or no change in mRS), symptomatic ICH(sICH), 90-day mortality, and successful recanalization (Thrombolysis in Cerebral Ischemia 2b-3).

Results We included 10 studies involving 1032 patients with pre-morbid disability and 4707 without pre-morbid disability. Patients with pre-morbid disability were more likely to return to baseline mRS (OR:2.10, 95%CI:1.49-2.95). Odds of favorable outcome were lower in patients with pre-morbid disability in unadjusted analyses but became comparable to patients without disability in adjusted analyses (adjusted OR:0.85, 95%CI:0.69-1.06). However, patients with pre-morbid disability had higher 90-day mortality (OR:3.48, 95%CI:2.96-4.09). sICH and successful recanalization rates were not significantly different between groups. Included studies showed moderate risk of bias. Heterogeneity was observed in return to baseline mRS and successful recanalization outcomes.

Conclusions

In eligible patients with pre-morbid disability, observational studies suggest that EVT carries comparable sICH risk and achieves comparable rates of recanalization and return to baseline as in patients without pre-morbid disability. However, discussions regarding thrombolysis in this group should acknowledge their much higher mortality, although it is unknown if this can be attributed to treatment. Our findings argue against the routine exclusion of patients with pre-morbid disability from EVT and merit validation with randomized controlled trials.

Authors/Disclosures
Benjamin Beland, MD PRESENTER	Dr. Beland has nothing to disclose.
	No disclosure on file
Mohammed Almekhlafi, MD (King Abdulaziz University Hospital)	Dr. Almekhlafi has nothing to disclose.
Eva A. Mistry, MD (UCCOM Neurology Stroke - 0525)	Dr. Mistry has received personal compensation in the range of $500-$4,999 for serving as a Consultant for RAPID AI. Dr. Mistry has received personal compensation in the range of $500-$4,999 for serving as a Consultant for AbbVIe. The institution of Dr. Mistry has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Silvercreek Pharma. Dr. Mistry has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Takeda Pharmaceuticals. Dr. Mistry has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for InspireMD. Dr. Mistry has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Shionogi. Dr. Mistry has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. The institution of Dr. Mistry has received research support from National Institutes of Health. The institution of Dr. Mistry has received research support from Patient Centered Outcomes Research Institure.
Mayank Goyal, MD, PhD	No disclosure on file
Aravind Ganesh, MD (Department of Clinical Neurosciences, University of Calgary)	Dr. Ganesh has received personal compensation in the range of $0-$499 for serving as a Consultant for Figure 1. Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Servier Canada. Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eisai. Dr. Ganesh has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli-Lilly. Dr. Ganesh has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Let's Get Proof (Collavidence Inc). Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for ��ɫ�� (journals Neurology and Neurology: Clinical Practice). Dr. Ganesh has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association (journal: Stroke). Dr. Ganesh has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Frontiers (for Frontiers in Neurology). Dr. Ganesh has or had stock in SnapDx.Dr. Ganesh has or had stock in Collavidence Inc.Dr. Ganesh has or had stock in DataSimpl. The institution of Dr. Ganesh has received research support from Canadian Institutes of Health Research . The institution of Dr. Ganesh has received research support from Alberta Innovates. The institution of Dr. Ganesh has received research support from University of Calgary Centre for Clinical Research. The institution of Dr. Ganesh has received research support from Innovation 4 Health. The institution of Dr. Ganesh has received research support from Government of Canada INOVAIT. The institution of Dr. Ganesh has received research support from Campus Alberta Neuroscience. The institution of Dr. Ganesh has received research support from Alzheimer Society of Canada. The institution of Dr. Ganesh has received research support from Heart and Stroke Foundation of Canada. The institution of Dr. Ganesh has received research support from New Frontiers in Research Fund. The institution of Dr. Ganesh has received research support from Panmure House. The institution of Dr. Ganesh has received research support from Brain Canada. The institution of Dr. Ganesh has received research support from MSI Foundation. The institution of Dr. Ganesh has received research support from France Canada Research Fund. Dr. Ganesh has received intellectual property interests from a discovery or technology relating to health care.

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