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Delayed functional independence after thrombectomy: temporal characteristics and predictors.

Shashvat M Desai1, Daniel A Tonetti2, Andrew A Morrison3

  • 1Department of Neurology and Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

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|June 4, 2020
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Summary
This summary is machine-generated.

Endovascular thrombectomy (EVT) for large vessel occlusion (LVO) stroke shows variable early improvement. Delayed functional independence occurs in one-third of non-early improvers, predicted by younger age and less severe stroke.

Keywords:
thrombectomy

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Area of Science:

  • Neurology
  • Interventional Neurology
  • Stroke Medicine

Background:

  • Variability in early neurological improvement following endovascular thrombectomy (EVT) for large vessel occlusion (LVO) stroke is recognized.
  • Understanding the temporal progression of functional independence after EVT is crucial for patient prognostication and rehabilitation planning.

Purpose of the Study:

  • To determine the incidence of early functional independence (EFI) and delayed functional independence (DFI) after EVT for anterior circulation LVO.
  • To identify predictors associated with achieving EFI and DFI.

Main Methods:

  • Retrospective analysis of prospectively collected data from patients undergoing EVT for anterior circulation LVO.
  • Evaluation of demographic, clinical, radiological, and procedural data.
  • Analysis of incidence and predictors for EFI (mRS 0-2 at discharge) and DFI (mRS 0-2 at 90 days in non-EFI patients).

Main Results:

  • Early functional independence (EFI) was achieved by 21% of patients.
  • Among patients without early improvement, 30% achieved delayed functional independence (DFI) by 90 days.
  • Shorter time to treatment, lower 24-hour NIHSS scores, and smaller infarct volumes predicted EFI. Younger age, lower 24-hour NIHSS scores, and absence of parenchymal hemorrhage predicted DFI.

Conclusions:

  • Approximately one-fifth of patients achieve early functional independence after EVT.
  • A significant proportion (one-third) of patients who do not improve early can still achieve functional independence later.
  • Younger age, lower initial stroke severity, and absence of hemorrhage are key predictors for delayed functional independence.