von Danwitz Niklas M, Bode Felix J, Samani Omid Shirvani, Asperger Hannah, Ebrahimi Taraneh, Kaesmacher Johannes, Layer Julia, Lehnen Nils, Nitsch Louisa, Meissner Julius N, Odensass Svenja, Stösser Sebastian, Thielscher Christian, Zidan Mousa, Dorn Franziska, Petzold Gabor C, Weller Johannes M
Department of Vascular Neurology, University Hospital Bonn, Bonn, Germany.
German Center for Neurodegenerative Diseases, Bonn, Germany.
Eur Stroke J. 2025 Jun 11:23969873251342048. doi: 10.1177/23969873251342048.
Predicting functional outcomes following endovascular treatment (EVT) for large-vessel occlusion stroke (LVOS) is challenging. Some patients achieve functional independence (modified Rankin Scale (mRS) 0 -2) at 90 days despite being dependent at discharge, termed delayed functional independence (DFI), while others lose independence after discharge, termed delayed functional dependence (DFD). This study explores patterns and predictors of DFI and DFD in LVOS patients undergoing EVT.
We analyzed anterior circulation LVOS patients from the prospective multicenter German Stroke Registry. Multivariable logistic regression models identified independent predictors of DFI and DFD.
Of 5909 patients, 2346 were independent at discharge, with 16.1% experiencing DFD at 90 days. DFD was associated with older age (median 78 vs 69 years, < 0.001), female sex (61.4% vs 46.1%, < 0.001), and greater stroke severity. Variables associated with DFD in multivariable analysis included older age, female sex, higher premorbid and discharge mRS, higher NIHSS at discharge, and absence of IV thrombolysis. Of 3563 patients dependent at discharge, 20.6% achieved DFI. DFI patients were younger (median 71 vs 77 years, < 0.001), less likely female (38.7% vs 52.6%, < 0.001) and had lower admission NIHSS, better pre-stroke functional status, higher ASPECTS and more frequent successful recanalization. Variables associated with DFI in multivariable analysis included younger age, male sex, better pre-stroke functional status, lower stroke severity and successful recanalization.
Both DFD and DFI are frequent in clinical practice, with higher DFD and lower DFI rates in women, which warrants further investigation. Understanding these predictors can enhance individualized patient counseling and management strategies.
预测大血管闭塞性卒中（LVOS）血管内治疗（EVT）后的功能结局具有挑战性。一些患者尽管出院时仍依赖他人，但在90天时实现了功能独立（改良Rankin量表（mRS）0 - 2），称为延迟功能独立（DFI），而另一些患者出院后失去了独立性，称为延迟功能依赖（DFD）。本研究探讨了接受EVT的LVOS患者中DFI和DFD的模式及预测因素。
我们分析了前瞻性多中心德国卒中登记处的前循环LVOS患者。多变量逻辑回归模型确定了DFI和DFD的独立预测因素。
在5909例患者中，2346例出院时独立，16.1%在90天时出现DFD。DFD与年龄较大（中位数78岁对69岁，<0.001）、女性（分别为61.4%对46.1%，<0.001）及卒中严重程度较高有关。多变量分析中与DFD相关的变量包括年龄较大、女性、病前和出院时mRS较高、出院时NIHSS较高以及未进行静脉溶栓。在3563例出院时依赖他人的患者中，20.6%实现了DFI。DFI患者年龄较小（中位数71岁对77岁，<0.001）、女性可能性较小（分别为38.7%对52.6%，<0.001），入院时NIHSS较低、卒中前功能状态较好、ASPECTS较高且再通成功率较高。多变量分析中与DFI相关的变量包括年龄较小、男性、卒中前功能状态较好、卒中严重程度较低及再通成功。
DFD和DFI在临床实践中均较为常见，女性的DFD率较高而DFI率较低，这值得进一步研究。了解这些预测因素可加强个体化的患者咨询和管理策略。
