Late-Stage Endovascular Therapy Linked to Quality of Life Improvements

Endovascular therapy given 6 to 16 hours after stroke onset preserves social capabilities and mental health, as well as improves functional outcomes, leading to overall quality of life benefits, according to research presented at the 2019 International Stroke Conference, held February 6-8, 2019, in Honolulu, Hawaii.  

As little is known regarding the effect of endovascular therapy on patient quality of life, researchers analyzed data from the DEFUSE 3 trial to assess if thrombectomies performed within the late time window (6 to 16 hours) would lead to quality of life improvements. Baseline impairment was quantified using the NIH Stroke Scale (NIHSS). End point measurements were performed using Neuro-QoL short forms administered at day 90.

Domains assessed included ability to participate in social activities and roles, mobility, depression, and cognitive function. Scores were transformed into T-scores to calibrate them to the general US adult population distribution with a standard deviation of 10 and a mean score of 50. For consistency, depression T-score distribution was inverted across the mean so that higher scores could reflect better outcomes. Adjusted linear regression and the unadjusted Wilcoxon rank-sum test were used to compare quality of life scores between groups.

In the DEFUSE 3 trial, 146 participants were alive at day 90, and 128 had completed all 4 quality of life forms. Ten participants completed none of the forms, and 8 completed only a subset of the forms. Endovascular therapy compared with medical therapy alone was associated with superior outcomes in all quality of life domains: social participation (P <.001), mobility (P <.001), depression (P =.003), and cognition (P =.013). Higher baseline NIHSS score was associated with worse outcomes in social participation, mobility, and cognition; older age was associated with worse depression and mobility; and female gender was associated with worse mobility, depression, and cognition (multivariable P <.05). Endovascular therapy benefits remained significant in each quality of life domain after adjusting for these variables.

Study investigators concluded that patient functional outcomes, social capabilities, mental health, and quality of life can be improved with endovascular therapy 6 to 16 hours after stroke onset.

Disclosures: Several researchers disclosed financial connections to iSchemaView, Medtronic, and ThrombX Medical.

Reference

Polding LC, Tate WJ, Mlynash M, et al. Improved quality of life with endovascular therapy in the DEFUSE 3 trial. Presented at: 2019 International Stroke Conference. February 6-8, 2019; Honolulu, HI. Abstract 5.