Department of Clinical Neurosciences, University of Calgary, Canada (R.A.J.).
Division of Neurosurgery (A.D.R.), University of British Columbia, Vancouver, Canada.
Stroke. 2021 May;52(5):1636-1642. doi: 10.1161/STROKEAHA.120.033872. Epub 2021 Mar 11.
Endovascular thrombectomy (EVT) reduces 90-day disability in patients following acute ischemic stroke due to large vessel occlusion. Patient-reported outcome measures after EVT, such as health-related quality of life and specific functional domains, are less well described.
We report outcomes on the EuroQol-5D (EQ-5D) from the ESCAPE (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times) randomized controlled trial at 90 days after stroke. Death was assigned an index value of 0 for EQ-5D. We used quantile regression to evaluate the association between EVT and EQ-5D index scores and logistic regression for the association between EVT and symptom-free status among 90-day survivors for each EQ-5D dimension (self-care, usual activities, mobility, pain/discomfort, and anxiety/depression), assessing for modification by age or sex and adjusting for baseline factors including stroke severity, affected hemisphere, and receipt of alteplase. Lastly, the association between severe disability at 90 days and EQ-5D was evaluated with assessment for modification by EVT, age, and sex.
There were 165 patients randomized to EVT and 150 patients randomized to control. Median EQ-5D was significantly higher for those who received EVT compared with best medical management (0.80 versus 0.60; P<0.001). After accounting for the greater number of deaths in the elderly, there was evidence of modification of treatment effect by age, with older age associated with a larger effect size difference in EQ-5D with EVT. Those receiving EVT had higher odds of symptom-free status in self-care, usual activities, mobility for those aged 60 to 79 years, and pain/discomfort for women, but there was no association with anxiety/depression. Severe disability at 90 days was associated with lower EQ-5D in older compared with younger individuals, and the association was not modified by EVT.
Patients treated with EVT report substantially improved health-related quality of life, with relatively greater impact in older individuals and observed benefit across multiple dimensions.
血管内血栓切除术（EVT）可降低急性缺血性卒中患者因大血管闭塞导致的 90 天残疾率。EVT 后患者报告的结局，如健康相关生活质量和特定功能领域，描述得较少。
我们报告了 ESCAPE（小核心和前循环近端闭塞的血管内治疗，重点是最小化 CT 至再通时间）随机对照试验中 90 天后卒中患者的 EuroQol-5D（EQ-5D）结果。死亡被分配 EQ-5D 的索引值为 0。我们使用分位数回归评估 EVT 与 EQ-5D 指数得分之间的关联，以及 90 天存活者中 EVT 与无症状状态之间的逻辑回归（每个 EQ-5D 维度：自我护理、日常活动、移动、疼痛/不适和焦虑/抑郁），评估年龄或性别对其的影响，并调整基线因素，包括卒中严重程度、受累半球和接受阿替普酶治疗。最后，评估 90 天重度残疾与 EQ-5D 的关联，并评估 EVT、年龄和性别对其的影响。
165 例患者随机接受 EVT，150 例患者随机接受最佳药物治疗。与最佳药物治疗相比，接受 EVT 的患者 EQ-5D 中位数明显更高（0.80 比 0.60；P<0.001）。在考虑到老年人中死亡人数较多的情况下，年龄对治疗效果有影响，EVT 与更大的 EQ-5D 效应大小差异与年龄较大有关。60-79 岁患者的自我护理、日常活动、移动能力和女性的疼痛/不适症状，接受 EVT 的患者无焦虑/抑郁症状的比例较高，但无关联。90 天重度残疾与老年患者的 EQ-5D 相关，与年轻患者相比，这种关联不受 EVT 的影响。
接受 EVT 治疗的患者报告健康相关生活质量显著改善，在年龄较大的患者中影响相对较大，并且在多个维度上都有获益。
