Expanding the evidence of endovascular treatment for acute ischemic stroke: patient–centered outcomes, population–level impact, and patients presenting with mild stroke symptoms
AdvisorHill, Michael D.
AuthorZerna, Anna Charlotte
Committee MemberDemchuck, Andrew M.
Rabi, Doreen M.
MetadataShow full item record
AbstractEndovascular treatment (EVT) for anterior circulation acute ischemic stroke due to large‐vessel occlusion is the new standard of care resulting in reduced disability compared to medical treatment. Practice guidelines recommend the use of EVT but can only speak to the evidence provided by clinical trials and might not be appropriate when complex medical decisions need to consider the heterogeneity of patients in routine clinical care. Brought about by the limitations of the clinical trials, the work described in this doctoral thesis aimed to assess the long–term sustainability of efficacy of EVT, the utilization of post–stroke outcomes that are patient–centered and more meaningful to affected individuals, and the effectiveness of EVT in patient populations that have not been part of clinical trial cohorts. These are commonly older patients with comorbidities and patients presenting with mild stroke symptoms. The miFUNCTION scale was shown to display greater granularity in the mild to moderately–severe disability range post–stroke compared to the modified Rankin Scale and thus provide more insight into the patient's ability and capacity to engage in meaningful life roles after EVT. In a population–based analysis, adult patients undergoing EVT spent on average more than one week longer at home within the first 90 days compared with patients receiving medical treatment. Home‐time was used as a novel, health‐economic, and patient‐centered outcome. For patients presenting with mild symptoms, EVT resulted in similar 90–day outcomes compared to medical management despite an increased risk of neurological deterioration at 24 hours. Due to uncertainty regarding the risk–benefit–ratio, a well–designed clinical trial will need to establish how best to treat these patients. Overall, the work described here provides greater understanding of how the benefits and risks of EVT might vary across the population and differ from the rather homogenous patient cohort that has been assessed in the clinical trials. The results of this research will be meaningful to patients who experience acute ischemic strokes caused by large vessel occlusion and also aid with economic and regulatory decisions to more broadly offer and organize EVT across Alberta and beyond.
CitationZerna, A. C. (2020). Expanding the evidence of endovascular treatment for acute ischemic stroke: patient–centered outcomes, population–level impact, and patients presenting with mild stroke symptoms (Unpublished doctoral thesis). University of Calgary, Calgary, AB.
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