Niklas M von Danwitz, Felix J Bode, Omid Shirvani Samani, Hannah Asperger, Taraneh Ebrahimi, Johannes Kaesmacher, Julia Layer, Nils Lehnen, Louisa Nitsch, Julius N Meissner, Svenja Odensass, Sebastian Stösser, Christian Thielscher, Mousa Zidan, Franziska Dorn, Gabor C Petzold, Johannes M Weller
{"title":"Patterns and predictors of delayed functional independence and dependence after thrombectomy in large vessel occlusion stroke: A multicenter analysis.","authors":"Niklas M von Danwitz, Felix J Bode, Omid Shirvani Samani, Hannah Asperger, Taraneh Ebrahimi, Johannes Kaesmacher, Julia Layer, Nils Lehnen, Louisa Nitsch, Julius N Meissner, Svenja Odensass, Sebastian Stösser, Christian Thielscher, Mousa Zidan, Franziska Dorn, Gabor C Petzold, Johannes M Weller","doi":"10.1177/23969873251342048","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Patients and methods: </strong>We analyzed anterior circulation LVOS patients from the prospective multicenter German Stroke Registry. Multivariable logistic regression models identified independent predictors of DFI and DFD.</p><p><strong>Results: </strong>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, <i>p</i> < 0.001), female sex (61.4% vs 46.1%, <i>p</i> < 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, <i>p</i> < 0.001), less likely female (38.7% vs 52.6%, <i>p</i> < 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.</p><p><strong>Discussion and conclusion: </strong>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.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251342048"},"PeriodicalIF":4.5000,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12162553/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Stroke Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/23969873251342048","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: 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.
Patients and methods: We analyzed anterior circulation LVOS patients from the prospective multicenter German Stroke Registry. Multivariable logistic regression models identified independent predictors of DFI and DFD.
Results: 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, p < 0.001), female sex (61.4% vs 46.1%, p < 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, p < 0.001), less likely female (38.7% vs 52.6%, p < 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.
Discussion and conclusion: 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.
导言: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。一些患者在出院时仍然依赖,但在90天内实现了功能独立(修改Rankin量表(mRS) 0 -2),称为延迟功能独立(DFI),而另一些患者在出院后失去独立性,称为延迟功能依赖(DFD)。本研究探讨了LVOS患者行EVT后DFI和DFD的模式和预测因素。患者和方法:我们分析了来自前瞻性多中心德国卒中登记的前循环LVOS患者。多变量logistic回归模型确定了DFI和DFD的独立预测因子。结果:5909例患者中,2346例在出院时独立,16.1%在90天出现DFD。DFD与老年相关(中位78岁vs 69岁,p p p p)讨论和结论:DFD和DFI在临床实践中都很常见,女性的DFD较高,DFI较低,值得进一步研究。了解这些预测因素可以提高个性化的患者咨询和管理策略。
期刊介绍:
Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.