Abstract
Background: Multiple randomized clinical trials have shown the benefits of thrombectomy in the treatment of acute stroke after 90 days; a recent study showed extended benefit in the functional outcomes of the original cohort of randomized patients. However, data on real-world experience on long-term outcomes, including recurrent vascular events and risk factor controls, is lacking. Aim: To study long-term clinical outcomes, risk factor modification, medication compliance, and recurrent events in patients undergoing thrombectomy in a community-based setting. Methods: Retrospective data was collected on 143 cases performed between 2013 and 2017 in a non-academic medical center. Long-term follow-up was performed by reviewing hospital and clinic records of available patients. Results: At the time of discharge, 79% of the 143 thrombectomy patients survived, 11% had died, and 10% went to hospice. Post-hospitalization data, ranging from 30-days to 3 years, was available in 83 patients. A majority of the survivors (81%) were living with family at home. Within that time frame, cardiovascular events occurred in 39% of patients, with 5 deaths (6%). Only 7% (6/83) of patients had a recurrent stroke; most of them were lacunar. Two patients had repeat thrombectomies, and one was treated with IV tpa. Seventy-nine percent (66/83) continued to be on anti-platelet agents. A surprising number (34/83) of long-term survivors continued to smoke and drink heavily (20/83). Only 78% of patients had regular medical care. Twenty-percent of survivors were depressed and 20% were demented. Conclusions: Although thrombectomy helps reduce disability and benefits stroke survival, there is a high incidence of cardiovascular and cerebrovascular events afterwards, due to poor control of risk factors, inadequate medical follow-up, and lack of lifestyle changes. Thrombectomy is a costly procedure; to be cost-effective in the long-term, it is imperative that the survivors are not left without proper medical surveillance and secondary prevention strategies.
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