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Published on: February 2, 2017
Early nutritional support enhances recovery after endovascular thrombectomy: A prospective study with institutional
Kota Maekawa1, Nobuyuki Ohara1, Naoki Higashibeppu2
1Department of Neurology, Kobe City Medical Center General Hospital, Hyogo, Japan.
Background & Aims:
The efficacy of nutritional support in patients after successful endovascular thrombectomy (EVT) remains unclear. This study aimed to determine whether individualized nutritional support through a multidisciplinary team approach could improve the clinical outcomes of patients who underwent EVT.
Methods:
This quasi-experimental study with a non-randomized controlled design compared a prospective cohort receiving individualized nutritional support with an institutional historical control cohort receiving standard care. Patients with acute ischemic stroke who underwent successful EVT (mTICI 2b-3) were included, and propensity score matching performed using age, sex, premorbid modified Rankin Scale (mRS) score, and initial National Institutes of Health Stroke Scale score, resulting in 42 matched pairs. The nutritional support group received individualized nutritional support by a multidisciplinary team targeting 30 kcal/kg/day of energy and 1.5 g/kg/day of protein within 7 days post-admission. Achievement was evaluated using two criteria: target achievement (≥70 % of goals of both energy and protein goals) and full target completion (100 % of both goals). The team monitored the swallowing function, metabolic parameters, and adjusted nutrition plans to safely achieve nutritional targets. The primary outcome was mRS score at 90 days.
Results:
The nutritional support group exhibited significantly improved 90-day mRS scores across multiple adjusted models (common odds ratio: 2.280-2.820, P < 0.05) and eliminated 90-day mortality (0 % vs. 23.8 %, P = 0.001). Target achievement (66.7 % vs. 31.0 %, P = 0.002) and full target completion (16.7 % vs. 2.4 %, P = 0.057) tended to be higher in the nutritional support group than in the control group. The proportion of complications, including aspiration pneumonia, diarrhea, and hyperglycemia, was comparable to or lower in the nutritional support group than in the control group.
Conclusions:
Early individualized nutritional support by a multidisciplinary team safely improves functional outcomes in patients with successful EVT. These findings support the implementation of team-based individualized nutritional support for patients following EVT.
