Endovascular therapy in acute ischaemic stroke patients with prestroke dependency-an EVA-TRISP cohort study

Acute EVT may be withheld from stroke patients with prestroke dependency on the help of others in daily activities because of insufficient randomised evidence. Using data from a large registry, we aimed to improve evidence for EVT decision-making in these patients.

Multicentre international observational study from the EndoVascular Therapy and ThRombolysis in Ischemic Stroke Patients (EVA-TRISP) collaboration comparing prestroke-dependent (prestroke mRS 3-4) with prestroke-independent patients (prestroke mRS 0-2). We used multivariate logistic regression analysis and report odds ratios (ORs) and 95% CIs. Outcomes were poor functional outcome in survivors (defined relative to the prestroke mRS), 3 month mortality, sICH occurrence and unsuccessful recanalisation.

Of 13,525 eligible patients, 1436 (10.6%) were prestroke-dependent. These patients were older (median 84 vs 73 years), more often women (61.0% vs 46.7%) and had higher NIHSS score (median 16 vs 14 points). While the odds of death (ORadjusted 2.33 [95% CI, 2.04-2.66]; 48.6% vs 19.6%) and unsuccessful recanalisation (ORadjusted 1.16 [95% CI, 1.02-1.33]; 31.0% vs 26.6%) were higher in prestroke-dependent patients, there was no evidence of increased odds of poor functional outcome in survivors (ORadjusted 0.68 [95% CI, 0.57-0.81]; 42.8% vs 40.0%) and sICH (ORadjusted 0.72 [95% CI, 0.53-0.98]; 3.8% vs 4.6%).

Despite higher mortality and recanalisation failure, prestroke-dependent patients did not have worse functional outcomes among survivors or higher sICH risk. This suggests that EVT should not be withheld solely on the basis of prestroke dependency.