Cognitive outcomes improved with endovascular therapy in acute ischemic stroke

Key takeaways:

• Researchers engaged in a secondary analysis of the ESCAPE clinical trial in patients with acute ischemic stroke.
• Higher odds of favorable outcome were recorded across all five cognitive tests.

Endovascular therapy was linked with improved outcomes across five cognitive tests in those with acute ischemic stroke, according to research published in Neurology.

“The incidence of dementia is estimated at 8.2% at 1 year after minor stroke and 34% after severe stroke,” Raed A. Joundi, MD, DPhil, a stroke neurologist at Hamilton Health Sciences in Ontario, Canada, and colleagues wrote. “As such, interventions to reduce cognitive impairment has been identified as a priority by stroke survivors.

Joundi and colleagues aimed to evaluate the effect of endovascular therapy (EVT) on cognitive function by analyzing results of the Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion with Emphasis on Minimizing CT to Recanalization Times (ESCAPE) trial.

Their study examined data from 315 individuals with acute ischemic stroke, roughly half of whom received EVT (n = 165) and the other cohort as matched controls. Participants underwent cognitive assessments 90 days post-stroke via the Montreal Cognitive Assessment (MoCA), Sunnybrook Neglect Assessment Procedure (SNAP), Boston Naming Test (BNT), Trail-making test A (Trails A), and Trail-making test B (Trails B). Not all participants were able to complete the testing due to cognitive impairment or death and were subsequently placed in the unfavorable performance group.

The researchers utilized logistic regression to evaluate the association between EVT and favorable outcomes based on scores of the five cognitive tests, adjusting for demographic and clinical factors. They additionally employed generalized estimating equations and ordinal regression to determine odds of favorable outcome with EVT on global cognition based on scores from the tests, adding final infarct volume (FIV) on MRI or computerized tomography 24 to 48 hours post stroke to the models to assess its relationship with cognitive outcome.

The researchers reported higher odds of favorable outcome with EVT for all five cognitive tests: MoCA (adjusted OR = 2.32; 95% CI, 1.3–4.16), SNAP (aOR = 3.85; 95% CI, 2–7.45), BNT (aOR = 2.33; 95% CI, 1.3–4.17), 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, higher odds of favorable outcome with EVT were recorded with 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. Upon further analyses, both FIV and EVT were also significantly associated with cognitive outcome.

“We believe the results represent compelling randomized trial evidence for the cognitive benefit of acute stroke therapy because they are consistent across domains of cognitive function,” Joundi and colleagues wrote.