Your browser doesn't support javascript.
loading
Effect of Endovascular Thrombectomy for Acute Ischemic Stroke on Cognitive Outcomes: A Secondary Analysis of the ESCAPE Trial.
Joundi, Raed A; Smith, Eric E; Mandzia, Jennifer; Ganesh, Aravind; Menon, Bijoy K; Rempel, Jeremy L; Thornton, John; Roy, Daniel; Jovin, Tudor G; Dowlatshahi, Dar; Frei, Donald F; Bharatha, Aditya; Poppe, Alexandre; Silver, Frank L; Shuaib, Ashfaq; Teitelbaum, Jeanne S; Williams, David; Bang, Oh Young; Sapkota, Biggya L; Burns, Paul; Choe, Hana; Heo, Jie-Hoe; Kelly, Michael E; Linares, Guillermo; Shankar, Jai J; Sohn, Sung-Il; Swartz, Richard H; Barber, Philip; Coutts, Shelagh B; Demchuk, Andrew; Goyal, Mayank; Hill, Michael D.
Afiliação
  • Joundi RA; From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Ontario; Department of Clinical Neurosciences (E.E.S., B.K.M., A.G., P. Barber, S.B.C., A.D., M.G., M.D.H.), Hotchkiss Brain Institute, Departments of Radiolog
  • Smith EE; From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Ontario; Department of Clinical Neurosciences (E.E.S., B.K.M., A.G., P. Barber, S.B.C., A.D., M.G., M.D.H.), Hotchkiss Brain Institute, Departments of Radiolog
  • Mandzia J; From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Ontario; Department of Clinical Neurosciences (E.E.S., B.K.M., A.G., P. Barber, S.B.C., A.D., M.G., M.D.H.), Hotchkiss Brain Institute, Departments of Radiolog
  • Ganesh A; From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Ontario; Department of Clinical Neurosciences (E.E.S., B.K.M., A.G., P. Barber, S.B.C., A.D., M.G., M.D.H.), Hotchkiss Brain Institute, Departments of Radiolog
  • Menon BK; From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Ontario; Department of Clinical Neurosciences (E.E.S., B.K.M., A.G., P. Barber, S.B.C., A.D., M.G., M.D.H.), Hotchkiss Brain Institute, Departments of Radiolog
  • Rempel JL; From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Ontario; Department of Clinical Neurosciences (E.E.S., B.K.M., A.G., P. Barber, S.B.C., A.D., M.G., M.D.H.), Hotchkiss Brain Institute, Departments of Radiolog
  • Thornton J; From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Ontario; Department of Clinical Neurosciences (E.E.S., B.K.M., A.G., P. Barber, S.B.C., A.D., M.G., M.D.H.), Hotchkiss Brain Institute, Departments of Radiolog
  • Roy D; From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Ontario; Department of Clinical Neurosciences (E.E.S., B.K.M., A.G., P. Barber, S.B.C., A.D., M.G., M.D.H.), Hotchkiss Brain Institute, Departments of Radiolog
  • Jovin TG; From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Ontario; Department of Clinical Neurosciences (E.E.S., B.K.M., A.G., P. Barber, S.B.C., A.D., M.G., M.D.H.), Hotchkiss Brain Institute, Departments of Radiolog
  • Dowlatshahi D; From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Ontario; Department of Clinical Neurosciences (E.E.S., B.K.M., A.G., P. Barber, S.B.C., A.D., M.G., M.D.H.), Hotchkiss Brain Institute, Departments of Radiolog
  • Frei DF; From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Ontario; Department of Clinical Neurosciences (E.E.S., B.K.M., A.G., P. Barber, S.B.C., A.D., M.G., M.D.H.), Hotchkiss Brain Institute, Departments of Radiolog
  • Bharatha A; From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Ontario; Department of Clinical Neurosciences (E.E.S., B.K.M., A.G., P. Barber, S.B.C., A.D., M.G., M.D.H.), Hotchkiss Brain Institute, Departments of Radiolog
  • Poppe A; From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Ontario; Department of Clinical Neurosciences (E.E.S., B.K.M., A.G., P. Barber, S.B.C., A.D., M.G., M.D.H.), Hotchkiss Brain Institute, Departments of Radiolog
  • Silver FL; From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Ontario; Department of Clinical Neurosciences (E.E.S., B.K.M., A.G., P. Barber, S.B.C., A.D., M.G., M.D.H.), Hotchkiss Brain Institute, Departments of Radiolog
  • Shuaib A; From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Ontario; Department of Clinical Neurosciences (E.E.S., B.K.M., A.G., P. Barber, S.B.C., A.D., M.G., M.D.H.), Hotchkiss Brain Institute, Departments of Radiolog
  • Teitelbaum JS; From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Ontario; Department of Clinical Neurosciences (E.E.S., B.K.M., A.G., P. Barber, S.B.C., A.D., M.G., M.D.H.), Hotchkiss Brain Institute, Departments of Radiolog
  • Williams D; From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Ontario; Department of Clinical Neurosciences (E.E.S., B.K.M., A.G., P. Barber, S.B.C., A.D., M.G., M.D.H.), Hotchkiss Brain Institute, Departments of Radiolog
  • Bang OY; From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Ontario; Department of Clinical Neurosciences (E.E.S., B.K.M., A.G., P. Barber, S.B.C., A.D., M.G., M.D.H.), Hotchkiss Brain Institute, Departments of Radiolog
  • Sapkota BL; From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Ontario; Department of Clinical Neurosciences (E.E.S., B.K.M., A.G., P. Barber, S.B.C., A.D., M.G., M.D.H.), Hotchkiss Brain Institute, Departments of Radiolog
  • Burns P; From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Ontario; Department of Clinical Neurosciences (E.E.S., B.K.M., A.G., P. Barber, S.B.C., A.D., M.G., M.D.H.), Hotchkiss Brain Institute, Departments of Radiolog
  • Choe H; From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Ontario; Department of Clinical Neurosciences (E.E.S., B.K.M., A.G., P. Barber, S.B.C., A.D., M.G., M.D.H.), Hotchkiss Brain Institute, Departments of Radiolog
  • Heo JH; From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Ontario; Department of Clinical Neurosciences (E.E.S., B.K.M., A.G., P. Barber, S.B.C., A.D., M.G., M.D.H.), Hotchkiss Brain Institute, Departments of Radiolog
  • Kelly ME; From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Ontario; Department of Clinical Neurosciences (E.E.S., B.K.M., A.G., P. Barber, S.B.C., A.D., M.G., M.D.H.), Hotchkiss Brain Institute, Departments of Radiolog
  • Linares G; From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Ontario; Department of Clinical Neurosciences (E.E.S., B.K.M., A.G., P. Barber, S.B.C., A.D., M.G., M.D.H.), Hotchkiss Brain Institute, Departments of Radiolog
  • Shankar JJ; From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Ontario; Department of Clinical Neurosciences (E.E.S., B.K.M., A.G., P. Barber, S.B.C., A.D., M.G., M.D.H.), Hotchkiss Brain Institute, Departments of Radiolog
  • Sohn SI; From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Ontario; Department of Clinical Neurosciences (E.E.S., B.K.M., A.G., P. Barber, S.B.C., A.D., M.G., M.D.H.), Hotchkiss Brain Institute, Departments of Radiolog
  • Swartz RH; From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Ontario; Department of Clinical Neurosciences (E.E.S., B.K.M., A.G., P. Barber, S.B.C., A.D., M.G., M.D.H.), Hotchkiss Brain Institute, Departments of Radiolog
  • Barber P; From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Ontario; Department of Clinical Neurosciences (E.E.S., B.K.M., A.G., P. Barber, S.B.C., A.D., M.G., M.D.H.), Hotchkiss Brain Institute, Departments of Radiolog
  • Coutts SB; From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Ontario; Department of Clinical Neurosciences (E.E.S., B.K.M., A.G., P. Barber, S.B.C., A.D., M.G., M.D.H.), Hotchkiss Brain Institute, Departments of Radiolog
  • Demchuk A; From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Ontario; Department of Clinical Neurosciences (E.E.S., B.K.M., A.G., P. Barber, S.B.C., A.D., M.G., M.D.H.), Hotchkiss Brain Institute, Departments of Radiolog
  • Goyal M; From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Ontario; Department of Clinical Neurosciences (E.E.S., B.K.M., A.G., P. Barber, S.B.C., A.D., M.G., M.D.H.), Hotchkiss Brain Institute, Departments of Radiolog
  • Hill MD; From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Ontario; Department of Clinical Neurosciences (E.E.S., B.K.M., A.G., P. Barber, S.B.C., A.D., M.G., M.D.H.), Hotchkiss Brain Institute, Departments of Radiolog
Neurology ; 102(10): e209270, 2024 May 28.
Article em En | MEDLINE | ID: mdl-38739880
ABSTRACT
BACKGROUND AND

OBJECTIVES:

The effect of endovascular therapy (EVT) for large vessel occlusion stroke on cognitive outcomes is not well understood. We evaluated the effect of EVT on cognitive function in the Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times (ESCAPE) trial.

METHODS:

Patient data from the ESCAPE randomized trial were analyzed. Cognitive assessments completed at 90 days after stroke were the Montreal Cognitive Assessment (MoCA), the Sunnybrook Neglect Assessment Procedure (SNAP), the Boston Naming Test (BNT), Trail-making test A (Trails A), and Trail-making test B (Trails B). We used logistic regression to evaluate the association between EVT and favorable cognitive outcome on the 5 separate tests, adjusting for demographic and clinical factors. We used generalized estimating equations and ordinal regression to determine the odds of favorable outcome with EVT on global cognition incorporating the 5 tests. We added final infarct volume (FIV) to the models to assess the relationship of FIV with cognitive outcome.

RESULTS:

The ESCAPE trial included 315 patients, 165 randomized to EVT and 150 randomized to control. There was higher odds of favorable outcome with EVT for MoCA (adjusted odds ratio [aOR] 2.32, 95% CI 1.30-4.16), SNAP (aOR 3.85, 95% CI 2.00-7.45), BNT (aOR 2.33, 95% CI 1.30-4.17), trails A (aOR 3.50, 95% CI 1.93-6.36), and trails B (aOR 2.56, 95% CI 1.46-4.48). There was higher odds of favorable outcome with EVT on global binary (aOR 2.57, 95% CI 1.67-3.94) and ordinal analyses (aOR 2.83, 95% CI 1.68-4.76) of cognitive function. After adding FIV to the models, both FIV and EVT were significantly associated with cognitive outcome. There was a significant correlation between global cognitive performance and mRS at day 90 (r = -0.78, p < 0.001), with the largest reductions in favorable cognitive outcome from mRS score 4 to 5 and from mRS 2 to 3.

DISCUSSION:

In this secondary analysis of the ESCAPE trial, EVT was associated with favorable outcome on 5 separate cognitive tests and in global analyses of cognitive benefit. These results provide novel evidence for the effect of EVT on cognition and support the global benefit of treatment with EVT. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that in patients with acute ischemic stroke due to intracranial internal carotid artery (ICA) or M1 segment MCA occlusion, including tandem extracranial ICA occlusions, EVT compared with best medical therapy increased odds of favorable cognitive outcome.
Assuntos
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Trombectomia / Procedimentos Endovasculares / AVC Isquêmico Limite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Neurology Ano de publicação: 2024 Tipo de documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Trombectomia / Procedimentos Endovasculares / AVC Isquêmico Limite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Neurology Ano de publicação: 2024 Tipo de documento: Article