@article{c01bb596429d4d90b9a96ca14ff8ad9c,
title = "Outcomes of Endovascular Therapy in Patients with Prestroke Mobility Impairment",
abstract = "Background and Purpose: Patients with prestroke mobility impairment (PSMI) were excluded from endovascular clinical trials. There are limited data regarding safety and outcomes of endovascular thrombectomy in this population. We used a large, national data set (Get With The Guidelines-Stroke) to evaluate the safety and outcomes of endovascular thrombectomy in patients with PSMI. Methods: We included patients who underwent endovascular thrombectomy in the Get With The Guidelines-Stroke registry between 2015 and 2019. PSMI was defined as the inability to ambulate independently. Generalized estimating equations for logistic regression models were used to evaluate the association between PSMI and outcomes. Results: Of 56 762 patients treated with endovascular thrombectomy, 2919 (5.14%) had PSMI. PSMI was not associated with symptomatic intracranial hemorrhage (6.0% versus 5.4%; P=0.979). In-hospital death or discharge to hospice occurred in 32.3% of patients with PSMI versus 17.5% without PSMI (adjusted odds ratio, 1.45 [1.32-1.58]). Conclusions: While procedural adverse outcomes were no higher in patients with PSMI, further study is necessary to determine clinical benefit in this population.",
keywords = "hospital mortality, ischemic stroke, logistic models, mortality, thrombectomy",
author = "Rachel Beekman and Sun, {Jie Lena} and Brooke Alhanti and Schwamm, {Lee H.} and Smith, {Eric E.} and Bhatt, {Deepak L.} and Ying Xian and Shreyansh Shah and Lytle, {Barbara L.} and Fonarow, {Gregg C.} and Sheth, {Kevin N.}",
note = "Funding Information: Dr Schwamm reports the following relationships relevant to research grants or companies that manufacture products for thrombolysis or thrombectomy: scientific consultant regarding trial design and conduct on late-window thrombolysis and member of steering committee for Genentech (TIMELESS; Tenecteplase in Stroke Patients Between 4.5 and 24 Hours; NCT03785678); user interface design and usability to LifeImage (privately held teleradiology company); stroke systems of care to the Massachusetts Department of Public Health; member of a Data Safety Monitoring Board (DSMB) for Penumbra (MIND; Artemis in the Removal of Intracerebral Hemorrhage; NCT03342664); Diffusion Pharma (PHAST-TSC; Efficacy and Safety of Trans Sodium Crocetinate [TSC] for Treatment of Suspected Stroke; NCT03763929); PI, multicenter trial of stroke prevention for Medtronic (Stroke AF; Rate of Atrial Fibrillation Through 12 Months in Patients With Recent Ischemic Stroke of Presumed Known Origin; NCT02700945); PI, late-window thrombolysis trial, National Institute of Neurological Disorders and Stroke (P50NS051343; MR WITNESS; A Study of Intravenous Thrombolysis With Alteplase in MRI-Selected Patients; NCT01282242); principal investigator, StrokeNet Network, National Institute of Neurological Disorders and Stroke (New England Regional Coordinating Center U24NS107243). Dr Bhatt discloses the following relationships: advisory board: Cardax, CellProthera, Cereno Scientific, Elsevier Practice Update Cardiology, Level Ex, Medscape Cardiology, MyoKardia, PhaseBio, PLx Pharma, and Regado Biosciences; board of directors: Boston VA Research Institute, Society of Cardiovascular Patient Care, TobeSoft; chair: American Heart Association Quality Oversight Committee; data monitoring committees: Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO-IDE trial [Portico Re-Sheathable Transcatheter Aortic Valve System US IDE Trial], funded by St. Jude Medical, now Abbott), Cleveland Clinic (including for the ExCEED trial [CENTERA THV System in Intermediate Risk Patients Who Have Symptomatic, Severe, Calcific, Aortic Stenosis], funded by Edwards), Contego Medical (Chair, PERFORMANCE 2 [Protection Against Emboli During Carotid Artery Stenting Using a 3-in-1 Delivery System Comprised of a Post-Dilation Balloon, Integrated Embolic Filter, and a Novel Carotid Stent II]), Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine (for the ENVISAGE-TAVI AF trial [Edoxaban Compared to Standard Care After Heart Valve Replacement Using a Catheter in Patients With Atrial Fibrillation], funded by Daiichi Sankyo), Population Health Research Institute; honoraria: American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org; vice-chair, American College of Cardiology Accreditation Committee), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; REDUAL-PCI clinical trial [Evaluation of Dual Therapy With Dabigatran vs Triple Therapy With Warfarin in Patients With AF That Undergo a PCI With Stenting Percutaneous Coronary Intervention] steering committee funded by Boehringer Ingelheim; AEGIS-II [Study to Investigate CSL112 in Subjects With Acute Coronary Syndrome] executive committee funded by CSL Behring), Belvoir Publications (editor in chief, Harvard Heart Letter), Canadian Medical and Surgical Knowledge Translation Research Group (clinical trial steering committees), Duke Clinical Research Institute (clinical trial steering committees, including for the PRONOUNCE trial (A Trial Comparing Cardiovascular Safety of Degarelix Versus Leuprolide in Patients With Advanced Prostate Cancer and Cardiovascular Disease), funded by Ferring Pharmaceuticals), HMP Global (editor in chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (guest editor; associate editor), K2P (cochair, interdisciplinary curriculum), Level Ex, Medtelligence/ReachMD (Continuing Medical Education steering committees), MJH Life Sciences, Population Health Research Institute (for the COMPASS operations committee, publications committee, steering committee, and USA national coleader, funded by Bayer), Slack Publications (chief medical editor, Cardiology Today{\textquoteright}s Intervention), Society of Cardiovascular Patient Care (secretary/treasurer), WebMD (CME steering committees); other: Clinical Cardiology (deputy editor), NCDR-ACTION Registry Steering Committee (chair), VA The Clinical Assessment Reporting and Tracking (CART) Program Research and Publications Committee (chair); research funding: Abbott, Afimmune, Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Cardax, Chiesi, CSL Behring, Eisai, Ethicon, Ferring Pharmaceuticals, Forest Laboratories, Fractyl, HLS Therapeutics, Idorsia, Ironwood, Ischemix, Lexicon, Lilly, Medtronic, MyoKardia, Owkin, Pfizer, PhaseBio, PLx Pharma, Regeneron, Roche, Sanofi, Synaptic, The Medicines Company; royalties: Elsevier (editor, Cardiovascular Intervention: a Companion to Braunwald{\textquoteright}s Heart Disease); site coinvestigator: Biotronik, Boston Scientific, CSI, St. Jude Medical (now Abbott), Svelte; trustee: American College of Cardiology; unfunded research: FlowCo, Merck, Novo Nordisk, Takeda. Dr Fonarow reports research funding from the Patient Centered Outcome Research Institute, GWTG Steering Committee Member, and employee of University of California, which holds a patent on an endovascular device. Dr Sheth is supported by the NIH (U24NS107136, U24NS107215, R01NR018335, R01NS107215, U01NS106513, and R03NS112859) and the American Heart Association (18TPA34170180, 17CSA33550004, and 20SRG35540018). Yale also receives grants to support Dr Sheth{\textquoteright}s research from Biogen, Novartis, Hyperfine, and Bard. Dr Sheth receives equity from Alva and fees from Zoll for his role as a DSMB Chair. The other authors report no conflicts. Funding Information: The Get With The Guidelines–Stroke (GWTG-Stroke) program is provided by the American Heart Association/American Stroke Association. GWTG-Stroke is sponsored, in part, by Novartis, Boehringer Ingelheim Lilly, Novo Nordisk, Sanofi, AstraZeneca and Bayer. GWTG-Stroke has been funded in the past through support from Boeringher-Ingelheim, Merck, Bristol-Myers Squib/Sanofi Pharmaceutical Partnership, and the AHA Pharmaceutical Roundtable. Publisher Copyright: {\textcopyright} 2021 Lippincott Williams and Wilkins. All rights reserved.",
year = "2021",
month = nov,
day = "1",
doi = "10.1161/STROKEAHA.121.034464",
language = "English (US)",
volume = "52",
pages = "E725--E728",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "11",
}