Endovascular Therapy after Stroke Improved Quality of Life Outcomes for Patients

Quality of life outcomes improved for patients treated with endovascular therapy 6 to 16 hours after stroke versus standard therapy alone, according to secondary analysis of the DEFUSE 3 trial(Stroke. 2021 Apr. Epub ahead of print).

The efficacy of endovascular therapy in treating ischemic stroke 6 to 16 hours after onset was demonstrated in the DEFUSE 3 randomized clinical trial. “The objective of this secondary analysis is to analyze the effect of late-window endovascular treatment of ischemic stroke on quality of life(QoL) outcomes,” explained Laura C. Polding, Stanford University School of Medicine, and co-investigators.

In the DEFUSE 3 trial, 182 patients who presented with acute anterior circulation ischemic stroke between 6 and 16 hours after they were last known to be well, were randomized to receive endovascular thrombectomy plus standard medical therapy or standard medical therapy alone and were followed-up through 90 days poststroke.

Quality of life at day 90 was assessed with the QoL in Neurological Disorders measurement tool.

Approximately 95% of patients alive at day 90(n=136 of 146) filled out QoL in Neurological Disorders short forms.

Mobility, social participation, cognitive function, and depression QoL scores were better (P<0.01 for all) in patients treated with endovascular therapy versus standard therapy alone.

Other variables independently associated with better QoL were lower baseline National Institutes of Health Stroke scale, younger age, and male sex.

Researchers highlighted that the modified Rankin Scale used captured differences in QoL domains and accounted for a high proportion of the variability in mobility, moderate proportion in social participation but a low proportion in cognition and depression. They assessed patients’ outcomes in cognition and depression should be measured with dedicated QoL tools instead of the modified Rankin Scale.

Overall, the analysis found “patients treated with endovascular therapy 6 to 16 hours after stroke have better QoL than patients treated with medical therapy alone, including better mobility, more social participation, superior cognition and less depression,” Ms Polding concluded.—Kaitlyn Manasterski