Abstract 414: Stroke Severity in patients presenting beyond 24 hours of last known well ‐ a secondary analysis of SELECT LATE cohort study

Introduction Endovascular thrombectomy (EVT) is shown to be associated with better clinical outcomes even after 24 hours of stroke onset. However, how stroke severity affect this association has not been well‐established. Methods From SELECT LATE, a retrospective cohort study from 17 high volume EVT centers across US, Spain, Australia and New Zealand, patients were stratified based on median stroke severity (NIHSS ≤15 vs >15). The association of treatment arm and functional and safety outcomes was examined using appropriate regression models adjusted for confounders, with sensitivity analyses repeated using Inverse Probability of Treatment Weights (IPTW). Results Of 301 eligible patients, median age was 69 (59‐81) y and 50% participants were females. 159 (107 EVT, 52 MM) had NIHSS ≤15, whereas 142 (78 EVT, 64 MM) patients had NIHSS >15 at the time of presentation. As stroke severity increased, outcomes worsened in both overall (acOR: 0.93, 95% CI: 0.89‐0.97, p<0.001 for each point) and among patients receiving EVT (acOR: 0.94, 95% CI: 0.90‐0.99, p=0.021 for each point) – figure 1. EVT was associated with higher odds of functional independence in patients with NIHSS ≤15 (EVT: 53% vs MM: 18%, aOR: 3.56, 95% CI: 1.35‐9.43, p=0.011) – fig 2. Estimates of association also favored EVT in those with NIHSS >15 (EVT: 18% vs MM: 5%, aOR: 2.29, 95% CI: 0.43‐12.16, p=0.33), without significant heterogeneity (p‐interaction: 0.61). Similar results were also observed for ordinal shift in mRS and excellent outcome (mRS 0‐1) – table 1, and in sensitivity analyses using IPTW. Symptomatic ICH was also higher with EVT across both strata (NIHSS ≤15: EVT: 11% vs MM: 2%, aOR: 8.09, 95% CI: 0.63‐103.85, p=0.11 and NIHSS>15 – EVT: 10% vs MM: 2%, p=0.07). Conclusions Among patients presenting beyond 24 hours of last known well, outcomes worsened with increased stroke severity. However, estimates of association favored EVT in both lower and higher stroke severity strata, without significant heterogeneity. Further exploration of stroke severity and its effect of EVT outcomes and treatment effect is warranted. Figure 1. Predicted probability of functional independence by NIHSS across EVT vs MM. As stroke severity increased, outcomes worsened in both EVT and MM arms. Figure 2. Distribution of mRS scores at 90‐day follow‐up across NIHSS and treatment strata. EVT was associated with better functional outcomes across both NIHSS strata. Table 1. EVT association with functional and safety outcomes across NIHSS strata.

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Journal
Stroke Vascular and Interventional Neurology
Published
2024-11-01
DOI
https://doi.org/10.1161/svin.04.suppl_1.414
Primary Topic
Acute Ischemic Stroke Management
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article
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article

Abstract 414: Stroke Severity in patients presenting beyond 24 hours of last known well ‐ a secondary analysis of SELECT LATE cohort study

Deep Pujara, Abdalla E. A. Hassan, Navdeep Sangha, Adam N. Wallace et al.
Stroke Vascular and Interventional Neurology
Acute Ischemic Stroke Management
article

Abstract 414: Stroke Severity in patients presenting beyond 24 hours of last known well ‐ a secondary analysis of SELECT LATE cohort study

Deep Pujara, Abdalla E. A. Hassan, Navdeep Sangha, Adam N. Wallace, Amanda Opaskar, Santiago Ortega‐Gutiérrez, Amro Elrefaei, Margy McCullough‐Hicks, Gregory W. Albers, Nathan Manning, Timothy John Kleinig, James C. Grotta, Jordi Blasco, Michael Abraham, James Ernest Siegler, Nitin Goyal, Adam S Arthur, Spiros Blackburn, Bruce C.V. Campbell, Clark Sitton, A. Sarraj, Marc Ribó, Mark William Parsons, Juan F. Arenillas, Dennis Cordato, Teddy Y. Wu
article en

Abstract

Introduction Endovascular thrombectomy (EVT) is shown to be associated with better clinical outcomes even after 24 hours of stroke onset. However, how stroke severity affect this association has not been well‐established. Methods From SELECT LATE, a retrospective cohort study from 17 high volume EVT centers across US, Spain, Australia and New Zealand, patients were stratified based on median stroke severity (NIHSS ≤15 vs >15). The association of treatment arm and functional and safety outcomes was examined using appropriate regression models adjusted for confounders, with sensitivity analyses repeated using Inverse Probability of Treatment Weights (IPTW). Results Of 301 eligible patients, median age was 69 (59‐81) y and 50% participants were females. 159 (107 EVT, 52 MM) had NIHSS ≤15, whereas 142 (78 EVT, 64 MM) patients had NIHSS >15 at the time of presentation. As stroke severity increased, outcomes worsened in both overall (acOR: 0.93, 95% CI: 0.89‐0.97, p<0.001 for each point) and among patients receiving EVT (acOR: 0.94, 95% CI: 0.90‐0.99, p=0.021 for each point) – figure 1. EVT was associated with higher odds of functional independence in patients with NIHSS ≤15 (EVT: 53% vs MM: 18%, aOR: 3.56, 95% CI: 1.35‐9.43, p=0.011) – fig 2. Estimates of association also favored EVT in those with NIHSS >15 (EVT: 18% vs MM: 5%, aOR: 2.29, 95% CI: 0.43‐12.16, p=0.33), without significant heterogeneity (p‐interaction: 0.61). Similar results were also observed for ordinal shift in mRS and excellent outcome (mRS 0‐1) – table 1, and in sensitivity analyses using IPTW. Symptomatic ICH was also higher with EVT across both strata (NIHSS ≤15: EVT: 11% vs MM: 2%, aOR: 8.09, 95% CI: 0.63‐103.85, p=0.11 and NIHSS>15 – EVT: 10% vs MM: 2%, p=0.07). Conclusions Among patients presenting beyond 24 hours of last known well, outcomes worsened with increased stroke severity. However, estimates of association favored EVT in both lower and higher stroke severity strata, without significant heterogeneity. Further exploration of stroke severity and its effect of EVT outcomes and treatment effect is warranted. Figure 1. Predicted probability of functional independence by NIHSS across EVT vs MM. As stroke severity increased, outcomes worsened in both EVT and MM arms. Figure 2. Distribution of mRS scores at 90‐day follow‐up across NIHSS and treatment strata. EVT was associated with better functional outcomes across both NIHSS strata. Table 1. EVT association with functional and safety outcomes across NIHSS strata.

Stroke Vascular and Interventional NeurologyVol. 4(S1)
Universidad de Valladolid (ES), University of Iowa (US), University of Minnesota (US), Kaiser Permanente (US), University of Tennessee Health Science Center (US), The University of Melbourne (AU), Palo Alto University (US), Medical College of Wisconsin (US), University of Minnesota System (US), Bellvitge University Hospital (ES), UNSW Sydney (AU), University of Chicago (US), Los Angeles Medical Center (US), New Zealand Brain Research Institute (NZ), Vall d'Hebron Institut de Recerca (ES), Semmes Murphey Foundation (US), Hospital Clínic de Barcelona (ES), University of Kansas Medical Center (US), Valley Baptist Medical Center (US), Hospital Universitário Antônio Pedro (BR), Ingham Institute (AU), Aurora BayCare Medical Center (US), Hospital Clínico Universitario de Valladolid (ES), St. John Medical Center (US), St. Johns Hospital (IE), South Western Sydney Local Health District (AU), The University of Adelaide (AU), The University of Texas Health Science Center at Houston (US), Stanford University (US)
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Acute Ischemic Stroke Management
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