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Abstract 41: Functional Outcome Of Patients 85 Years Or Older With Acute Ischemic Stroke Following Endovascular Treatment - A Substudy Of The Hermes Meta-analysis
- Rosalie V McDonough,
- Johanna M Ospel,
- Bruce Campbell,
- Michael D Hill,
- Jeffrey L Saver,
- Diederik W Dippel,
- Andrew M Demchuk,
- Charles B Majoie,
- Scott Brown,
- Peter J Mitchell,
- Serge Bracard,
- francis guillemin,
- Tudor G Jovin,
- Keith W Muir,
- Philip White,
- Mayank Goyal
Stroke Volume 53, Issue Suppl_11 February 2022

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Introduction: Previous studies have reported poor outcomes and high rates of mortality following endovascular therapy (EVT) for ischemic stroke in older patients. However, patients ≥85 years were underrepresented in most randomized trials. Our aim was to study the influence of age on outcome and EVT effect for ischemic stroke in patients aged ≥85 years.Methods: Data were from the HERMES collaboration, a meta-analysis of 7 randomized trials that tested the efficacy of EVT. Two multivariable ordinal logistic regression were used to compare the association between EVT and 90-day functional outcome (modified Rankin Scale, primary outcome) in patients ≥85 years old to those who were younger. Secondary outcomes included mortality at 90 days and symptomatic intracranial hemorrhage (sICH) at 24 hours.Results: We included 1764 patients in the analysis, of whom 77 (4.4%) were ≥85 years old. While patients ≥85 years had worse outcomes (adjusted odds ratio [aOR] 0.26 (95%CI:0.14-0.48) and higher mortality rates (aOR:3.28, 95%CI:1.54-6.97) compared to those <85 years, a significant benefit of EVT was observed in the ≥85-year-old patient subgroup (common OR:4.20 (95%CI:1.56-11.32, Figure). Patients ≥85 years undergoing EVT had lower rates of mortality than those in the control group (31% vs. 54%, p<0.01). Age ≥85 years was not significantly associated with higher rates of sICH (adjusted cOR:2.3, 95%CI:0.59-8.93).Conclusion: Patients ≥85 years old with independent premorbid function more often achieve good functional outcomes when treated with EVT compared to conservative management, with lower rates of mortality and no differences in sICH rates. EVT should therefore not be withheld in this subgroup.
Abstract WMP89: Comparative Outcome Of Patients With And Without Mild Pre-Stroke Morbidity Following Endovascular Treatment - Results From The Hermes Meta-analysis
- Rosalie V McDonough,
- Johanna M Ospel,
- Charles B Majoie,
- Philip White,
- Diederik W Dippel,
- Scott Brown,
- Andrew M Demchuk,
- Tudor G Jovin,
- Peter J Mitchell,
- Serge Bracard,
- Bruce Campbell,
- Keith W Muir,
- Michael D Hill,
- Francis Guillemin,
- Mayank Goyal
Stroke Volume 53, Issue Suppl_11 February 2022

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Introduction: Analyses of the effect of prestroke functional levels upon outcome of endovascular therapy (EVT) have focused on the course of patients with moderate to substantial prestroke disability. The effect of complete freedom from pre-existing disability (modified Rankin Scale [mRS]=0) vs. predominantly mild pre-existing disability (mRS≥1) has not been well delineated.Methods: Data were from the HERMES collaboration, a meta-analysis of 7 randomized controlled trials that tested the safety and efficacy of EVT. Two multivariable ordinal logistic regression models were used to compare the association between EVT and 90-day mRS (primary outcome) in patients who were asymptomatic prestroke (mRS=0) and those who had predominantly mild disability prestroke (mRS≥1). Secondary outcomes included successful reperfusion (in the EVT subgroup) and symptomatic intracranial hemorrhage (sICH) at 24 hours.Results: We included 1764 patients in the analysis, of whom 223 (12.6%) had a prestroke mRS≥1 (162 mRS 1, 61 mRS≥2). Patients with prestroke mRS≥1 had worse outcomes compared to those with prestroke mRS=0 (adjusted odds ratio [aOR] 0.42 (95%CI:0.28-0.63). Nonetheless, a significant benefit of EVT was observed in the mRS≥1 subgroup (common OR:1.79 (95%CI:1.11-2.89, Figure). No significant differences were observed with regards to rates of reperfusion (aOR:0.91, 95%CI:0.52-1.57) and sICH (aOR:1.03, 95%CI:0.37-2.93) between patients asymptomatic vs. predominantly with mild disability prestroke.Conclusion: Patients completely asymptomatic prior to onset have better outcomes from EVT than those with mild disability. Patients with prestroke mRS=1 still do more often achieve good functional outcomes with EVT compared to conservative management, with similar rates of reperfusion and sICH. These findings indicate even mild pre-existing symptoms exert prognostic (outcome) but not predictive (different response to therapy) in patients eligible for EVT.
Functional Outcomes of Patients ≥85 Years With Acute Ischemic Stroke Following EVT: A HERMES Substudy
- Rosalie V. McDonough,
- Johanna M. Ospel,
- Bruce C.V. Campbell,
- Michael D. Hill,
- Jeffrey L. Saver,
- Diederik W.J. Dippel,
- Andrew M. Demchuk,
- Charles B.L.M. Majoie,
- Scott B. Brown,
- Peter J. Mitchell,
- Serge Bracard,
- Francis Guillemin,
- Tudor G. Jovin,
- Keith W. Muir,
- Philip White,
- Mayank Goyal and
Stroke Volume 53, Issue 71 July 2022

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Background:Observational studies have shown endovascular treatment (EVT) for acute ischemic stroke to be effective in the elderly, despite resulting in poorer outcomes and higher rates of mortality compared with younger patients. Randomized data on the effect of advanced age on outcomes following EVT are, however, lacking. Our aim was to assess the EVT effect for ischemic stroke in patients aged ≥85 years and the influence of age on outcome in a large, randomized trial dataset.Methods:Data were from the HERMES (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials) collaboration, a meta-analysis of 7 randomized trials published between January 1, 2010, and May 31, 2017, that tested the efficacy of EVT. A possible multiplicative interaction effect of age on the relationship between treatment and outcome was investigated. Ordinal logistic regression tested the association between EVT and 90-day functional outcome (modified Rankin Scale, primary outcome) in patients ≥85 years. Multivariable binary logistic regression was performed to compare primary and secondary outcomes (modified Rankin Scale score of 0–2/5–6) of patients ≥85 years versus those <85 years.Results:We included 1764 patients in the analysis, of whom 77 (4.4%) were ≥85 years old. A significant interaction of age and treatment on poor outcome (modified Rankin Scale score of 5–6, P=0.020) and mortality (P=0.031) was observed, with older adults having worse functional outcomes at 90 days compared with younger patients (adjusted common odds ratio, 0.20 [95% CI, 0.13–0.33]). However, a benefit of EVT was observed in the ≥85-year-old patient subgroup (common odds ratio, 4.20 [95% CI, 1.56–11.32]). Age ≥85 years was not significantly associated with differing rates of symptomatic intracerebral hemorrhage or reperfusion (adjusted odds ratio, 1.92 [95% CI, 0.71–5.15] and adjusted odds ratio, 0.91 [95% CI, 0.40–2.06], respectively).Conclusions:Patients ≥85 years old with independent premorbid function more often achieve good functional outcomes and have lower rates of mortality when treated with EVT compared with conservative management, with an observed treatment effect modification of age on outcome. EVT should therefore not be withheld in this subgroup.Graphical Abstract
Standardized Reporting of Workflow Metrics in Acute Ischemic Stroke Treatment: Why and How?
- Mayank Goyal,
- Jeffrey L. Saver,
- Aravind Ganesh,
- Rosalie V. McDonough,
- Yvo B.W.E.M. Roos,
- Grégoire Boulouis,
- Martin Kurz,
- Marios‐Nikos Psychogios,
- Staffan Holmin,
- Charles B.L.M. Majoie,
- Romain Bourcier,
- Ronil Chandra,
- Shinichi Yoshimura,
- Dileep Yavagal,
- Benjamin Gory,
- Christian Taschner,
- Brian Buck,
- Ashutosh Jadhav,
- Michael D. Hill and
- Johanna Maria Ospel
Stroke: Vascular and Interventional Neurology Volume 1, Issue 117 November 2021

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The benefit of acute ischemic stroke (AIS) treatment is highly time dependent. Although studies on workflow improvement in AIS are increasingly gaining attention, there is a lack of consensus and consistency regarding the definition, measurement, and reporting of AIS workflow times. We discuss the challenges related to defining and measuring workflow times in AIS and propose a basic set of time intervals that should be reported in AIS workflow studies. We particularly focus on patients undergoing mechanical thrombectomy. Importantly, endovascular treatment workflow times should always be reported in conjunction with reperfusion quality because one is not informative without the other. We further suggest standardized reporting of workflow times that includes the 90th percentile in addition to medians and interquartile ranges, means, and SDs. The proposed methodology serves as a framework for AIS studies and aids further discussion on workflow‐related AIS research.

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Abstract 41: Functional Outcome Of Patients 85 Years Or Older With Acute Ischemic Stroke Following Endovascular Treatment - A Substudy Of The Hermes Meta-analysis

Abstract

Abstract WMP89: Comparative Outcome Of Patients With And Without Mild Pre-Stroke Morbidity Following Endovascular Treatment - Results From The Hermes Meta-analysis

Abstract

Functional Outcomes of Patients ≥85 Years With Acute Ischemic Stroke Following EVT: A HERMES Substudy

Abstract

Standardized Reporting of Workflow Metrics in Acute Ischemic Stroke Treatment: Why and How?

Abstract