Abstract WP22: Differential Effect of Intra-arterial Treatment for Acute Ischemic Stroke on Motor versus Language Deficit. A Post-hoc Mr Clean Subgroup Analysis

Abstract

Introduction: Clinical observations suggest that language deficits in acute ischemic stroke do not respond as rapidly to reperfusion therapy as motor deficits. We tested for a differential effect of intra-arterial treatment with retrievable stents on recovery from aphasia and upper limb paresis in MR CLEAN. Hypothesis: The early effect of IAT on recovery from language and motor deficits is similar in size. Methods: All patients with aphasia who were randomized in MR CLEAN were included. Primary outcomes were the score on the NIH stroke scale item for upper extremity paresis contralateral to the affected hemisphere, and the score for language, at 24 hours and 5-7 days after treatment. We estimated the effect of IAT on the shift on these item scores and tested for a differential effect of IAT on language versus motor recovery, by introducing a multiplicative term in a multilevel multivariable ordinal logistic regression model. Results: In total, 288 patients had an aphasia score of 1 or more. Of these 126 (44%) were assigned to IAT and 162 (56%) to no IAT. The common odds ratio (cOR) for improvement in language and motor score at 24 hours was 1.68 (1.06 to 2.67) and 2.51 (1.57 to 4.03) (p=0.006). At 5-7 days the cOR was 1.87 (1.18 to 2.98) for aphasia score and 2.41 (1.47 to 3.95) for motor deficit (p=0.011). The proportion of patients with good recovery at 5-7 days was similar (Figure). Conclusion: The early effect of IAT on language deficit is smaller than the effect on motor deficit, but final recovery after 1 week is similar.