Long-Term Outcome and Quality of Life in Patients With Stroke Presenting With Extensive Early Infarction

Area of Science:

• Neurology
• Interventional Neuroradiology
• Public Health

Background:

• Mechanical thrombectomy's benefit in low Alberta Stroke Program Early Computed Tomography Score (ASPECTS) patients is debated.
• Long-term outcomes for these patients remain largely unknown.
• This study investigates reperfusion grade's impact on long-term functional and quality-of-life outcomes in patients with varying baseline ASPECTS.

Purpose of the Study:

• To assess the association between reperfusion grade and long-term functional outcomes (modified Rankin Scale).
• To evaluate the impact of reperfusion grade on long-term health-related quality of life (EuroQol 5-dimensional questionnaire).
• To compare outcomes based on baseline ASPECTS (0-5 vs. 6-10).

Main Methods:

• Retrospective, monocentric cohort study of patients treated with mechanical thrombectomy (2010-2018).
• Long-term follow-up (median 3.67 years) including functional status and quality of life assessments.
• Reperfusion grade adjudicated using expanded Treatment in Cerebral Ischemia (eTICI) score; outcomes analyzed using multivariable logistic regression.

Main Results:

• In patients with low ASPECTS, higher reperfusion grades were linked to better long-term functional outcomes (aOR 1.43, P=0.01).
• Improved reperfusion also correlated with better long-term health-related quality of life (aCorr 0.05, P<0.05).
• Patients with low ASPECTS reported more mobility and self-care issues compared to high ASPECTS patients.

Conclusions:

• Higher reperfusion grades improve long-term functional outcomes in mechanical thrombectomy patients, even with low baseline ASPECTS.
• Enhanced reperfusion may positively impact long-term quality of life despite early extensive infarction.
• Reperfusion grade is a critical factor for long-term recovery in stroke patients undergoing thrombectomy.