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Abstract 414: Stroke Severity in patients presenting beyond 24 hours of last known well ‐ a secondary analysis of SELECT LATE cohort study
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Abstract 414: Stroke Severity in patients presenting beyond 24 hours of last known well ‐ a secondary analysis of SELECT LATE cohort study

A Elrefaei, D Pujara, T Kleinig, A Hassan, P Portela, S Ortega-Gutierrez, M Abraham, N Manning, J Siegler, N Goyal, …
Stroke: vascular and interventional neurology, Vol.4(S1)
11/01/2024
DOI: 10.1161/SVIN.04.suppl_1.414
PMCID: PMC12774237
url
https://doi.org/10.1161/SVIN.04.suppl_1.414View
Published (Version of record) Open Access

Abstract

IntroductionEndovascular thrombectomy (EVT) is shown to be associated with better clinical outcomes even after 24 hours of stroke onset. However, how stroke severity affect this association has not been well‐established.MethodsFrom SELECT LATE, a retrospective cohort study from 17 high volume EVT centers across US, Spain, Australia and New Zealand, patients were stratified based on median stroke severity (NIHSS ≤15 vs >15). The association of treatment arm and functional and safety outcomes was examined using appropriate regression models adjusted for confounders, with sensitivity analyses repeated using Inverse Probability of Treatment Weights (IPTW).ResultsOf 301 eligible patients, median age was 69 (59‐81) y and 50% participants were females. 159 (107 EVT, 52 MM) had NIHSS ≤15, whereas 142 (78 EVT, 64 MM) patients had NIHSS >15 at the time of presentation. As stroke severity increased, outcomes worsened in both overall (acOR: 0.93, 95% CI: 0.89‐0.97, p<0.001 for each point) and among patients receiving EVT (acOR: 0.94, 95% CI: 0.90‐0.99, p=0.021 for each point) – figure 1. EVT was associated with higher odds of functional independence in patients with NIHSS ≤15 (EVT: 53% vs MM: 18%, aOR: 3.56, 95% CI: 1.35‐9.43, p=0.011) – fig 2. Estimates of association also favored EVT in those with NIHSS >15 (EVT: 18% vs MM: 5%, aOR: 2.29, 95% CI: 0.43‐12.16, p=0.33), without significant heterogeneity (p‐interaction: 0.61). Similar results were also observed for ordinal shift in mRS and excellent outcome (mRS 0‐1) – table 1, and in sensitivity analyses using IPTW. Symptomatic ICH was also higher with EVT across both strata (NIHSS ≤15: EVT: 11% vs MM: 2%, aOR: 8.09, 95% CI: 0.63‐103.85, p=0.11 and NIHSS>15 – EVT: 10% vs MM: 2%, p=0.07).ConclusionsAmong patients presenting beyond 24 hours of last known well, outcomes worsened with increased stroke severity. However, estimates of association favored EVT in both lower and higher stroke severity strata, without significant heterogeneity. Further exploration of stroke severity and its effect of EVT outcomes and treatment effect is warranted.Figure 1. Predicted probability of functional independence by NIHSS across EVT vs MM. As stroke severity increased, outcomes worsened in both EVT and MM arms.Figure 2. Distribution of mRS scores at 90‐day follow‐up across NIHSS and treatment strata. EVT was associated with better functional outcomes across both NIHSS strata.Table 1. EVT association with functional and safety outcomes across NIHSS strata.
 Cohort Analysis Stroke

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