Abstract
BackgroundThe targeted use of endovascular therapy (EVT), with or without intravenous thrombolysis (IVT) in acute large cerebral vessel occlusion stroke (LVOS) has been proven to be superior compared to IVT alone. Despite favorable functional outcome, many patients complain about cognitive decline after EVT. If IVT in addition to EVT has positive effects on cognitive function is unclear.MethodsWe analyzed data from the German Stroke Registry (GSR, an open, multicenter and prospective observational study) and compared cognitive function 90 days after index ischemic stroke using MoCA in patients with independent (mRS ≤ 2 pts) and excellent (mRS = 0 pts) functional outcome receiving combined EVT and IVT (EVT + IVT) vs. EVT alone (EVT-IVT).ResultsOf the 2636 GSR patients, we included 166 patients with mRS ≤ 2 at 90 days in our analysis. Of these, 103 patients (62%) received EVT + IVT, 63 patients (38%) were treated with EVT alone. There was no difference in reperfusion status between groups (mTICI ≥ 2b in both groups at 95%, p = 0.65). Median MoCA score in the EVT + IVT group was 20 pts. (18–25 IQR) vs. 18 pts. (16–21 IQR) in the EVT-IVT group (p = 0.014). There were more patients with cognitive impairment (defined as MoCA < 26 pts) in the EVT-IVT group (54 patients (86%)) compared to the EVT + IVT group (78 patients (76%)). EVT + IVT was associated with a higher MoCA score at 90 days (mRS ≤ 2: p = 0.033, B = 2.39; mRS = 0: p = 0.021, B = 4.38).ConclusionsIn Patients with good functional outcome after LVOS, rates of cognitive impairment are lower with combined EVT and IVT compared to EVT alone.Trial registrationClinicalTrials.gov Identifier: NCT03356392.
Highlights
Ischemic stroke is one of the most frequent causes of permanent physical disability worldwide [1] and, in addition, is associated with an increasing incidence of cognitive impairment and dementia [2]
There was a significant shorter median symptom onset to admission time in patients with endovascular therapy (EVT) + intravenous thrombolysis (IVT) compared to in the EVT-IVT group (69 min, Interquartile range (IQR) 40–171 min vs 205 IQR 73–508 min in the EVT-IVT group, p < 0.001)
The proportion of smokers (37.1% vs. 27.3%, p = 0.19) and patients with anticoagulation (28,6% vs. 0%, p < 0.001) were higher in the EVT-IVT group compared to the EVT + IVT group
Summary
Ischemic stroke is one of the most frequent causes of permanent physical disability worldwide [1] and, in addition, is associated with an increasing incidence of cognitive impairment and dementia [2]. The exact pathogenesis so far remains unclear Since both ischemic stroke and cognitive impairment have an increasing prevalence in older age, the exact differentiation, especially of causality, is not easy. Pendlebury et al could show a significant deterioration of cognitive function associated with an ischemic event in patients with already beginning (age-correlated-physiological) cognitive impairment [14]. The functional “reserve” is lower in old age, which is reflected in the risk factors for a post-stroke cognitive disorder: Here, in addition to the age (> 65 years) and already known cognitive impairment, cerebral atrophy in the temporal lobe, recurrent ischemic strokes, cardioembolic infarcts and so-called “white matter lesions” are mentioned [16,17,18,19]. If IVT in addition to EVT has positive effects on cognitive function is unclear
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