Effect of Endovascular Thrombectomy for Acute Ischemic Stroke on Cognitive Outcomes
Published on: May 31, 2024
New research highlights the global benefit of endovascular therapy (EVT) on cognitive outcomes following acute ischemic stroke. Researchers for the Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times (ESCAPE) trial evaluated data for 315 patients (165 randomized to EVT and 150 randomized to control) to determine the effect of EVT on cognitive function. Ninety days post-stroke, patients were evaluated with the Montreal Cognitive Assessment (MoCA), the Sunnybrook Neglect Assessment Procedure (SNAP), the Boston Naming Test (BNT), Trail-making test A (Trails A), and Trail-making test B (Trails B). The likelihood of a favorable outcome with EVT was increased for MoCA (adjusted odds ratio [aOR] 2.32, 95% CI 1.30–4.16), SNAP (aOR 3.85, 95% CI 2.00–7.45), BNT (aOR 2.33, 95% CI 1.30–4.17), trails A (aOR 3.50, 95% CI 1.93–6.36), and trails B (aOR 2.56, 95% CI 1.46–4.48). In addition, global binary (aOR 2.57, 95% CI 1.67–3.94) and ordinal analyses (aOR 2.83, 95% CI 1.68–4.76) of cognitive function indicated an increased likelihood of a favorable outcome. There were also significant associations between cognitive outcome and final infarct volume and EVT in the models. At day 90, global cognitive performance and modified Rankin Score (mRS) were significantly correlated, including notable reductions in favorable cognitive outcome from mRS 4 to 5 and from mRS 2 to 3. “This study provides Class II evidence that in patients with acute ischemic stroke due to intracranial internal carotid artery (ICA) or M1 segment MCA occlusion, including tandem extracranial ICA occlusions, EVT compared with best medical therapy increased odds of favorable cognitive outcome,” the researchers conclude.