1053. Comparative Outcome Analysis of Endovascular Acute Ischemic Stroke Treatment in Patient With and Without Pre-stroke Disability
Authors: Sanjana Salwi; Akshitkumar Mistry; Kiersten Espaillat; Matthew Fusco; Michael Froehler; Rohan Chitale; Eva Mistry (Nashville, TN)
Introduction: Current guidelines recommend endovascular acute ischemic stroke (AIS) treatment for patients with no pre-stroke disability denoted as modified Rankin Score (mRS) 0 or 1. The benefit of endovascular treatment (EVT) in patients with pre-stroke disability (mRS 2 to 5) has not been systematically evaluated and warrants quantitative comparison. Methods: Pre-stroke disability was retrospectively determined for all patients who underwent EVT for AIS between 2012 and 2018 in a prospectively-maintained registry of a single institution. Patients were trichotomized based on pre-stroke mRS: no significant (mRS 0 to 1), moderate (mRS 2 to 3), and significant disability (mRS 4 to 5). The proportion of patients who had a successful 90-day outcome, defined as no worsening of disability on the mRS scale, was compared among groups. Secondary outcomes evaluated included successful recanalization (thrombolysis in cerebral ischemia, TICI ³ 2b), symptomatic hemorrhage, and in-hospital death. Results: Pre-stroke disability could be ascertained for 247 out of 269 eligible patients. Mean age of patients with no significant (n=137), moderate (n=100), and severe disability (n=10) was 59.5, 68.5, and 59 yrs (p=0.0002) and proportion of males was 56.9%, 37.5%, and 44.4%, respectively, (p=0.01). No significant differences in baseline NIH stroke scale and time from stroke onset to recanalization were noted among these groups. Successful outcome was noted in 42% (58/137) of those with no significant, 46% (46/100) of those with moderate, and 60% (6/10) of those with significant disability (chi-square statistic 1.32, p=0.52). No significant differences were noted in the rates of symptomatic hemorrhage or successful recanalization. Proportion with in-hospital death increased with pre-stroke disability: 6.7%, 14.9%, and 33.3%, respectively, (p=0.02). Conclusion: This retrospective, single-center comparative analysis of patients with and without pre-stroke disability demonstrates similar rates of successful clinical and procedural EVT outcomes. Prospective studies are warranted to confirm this finding.