Author Response: Prestroke Disability and Outcome After Thrombectomy for Emergent Anterior Circulation Large Vessel Occlusion Stroke
Adamde Havenon, Physician, Yale University
Submitted February 17, 2022
We thank Feng et al. for their insightful comment regarding the importance of understanding why patients in our study had pre-stroke disabilities, such as cardiovascular, cerebrovascular, or other morbidities, and the causes of death in the 90-day follow-up period.1 Unfortunately, this data was not available in the TRACK registry. Given the renewed interest in this subject area, specifically both endovascular thrombectomy and intravenous thrombolysis, we hope that more granular data will be available in the near future.
We also thank Siegler et al. for their comment. It would be ideal to perform a matched analysis of stroke patients with premorbid disability, observing those who did or did not receive endovascular thrombectomy, but that was not possible in the TRACK registry. Nonetheless, we do feel that the outcome of no accumulated disability is a valid endpoint, particularly given the limitations described in our manuscript.1 Adding mRS 0-2 to our outcome, as a composite outcome, creates a bias towards the null in our opinion. Ultimately, as the indications for endovascular thrombectomy become more inclusive, we will have to test many of these subgroup hypotheses in dedicated trials—in particular, premorbid disability, distal occlusion, and low stroke severity.
Disclosure
The author reports no relevant disclosures. Contact journal@neurology.org for full disclosures.
References
de Havenon A, Castonguay A, Nogueira R, et al. Prestroke Disability and Outcome After Thrombectomy for Emergent Anterior Circulation Large Vessel Occlusion Stroke [published online ahead of print, 2021 Sep 20]. Neurology. 2021;10.1212/WNL.0000000000012827.
We thank Feng et al. for their insightful comment regarding the importance of understanding why patients in our study had pre-stroke disabilities, such as cardiovascular, cerebrovascular, or other morbidities, and the causes of death in the 90-day follow-up period.1 Unfortunately, this data was not available in the TRACK registry. Given the renewed interest in this subject area, specifically both endovascular thrombectomy and intravenous thrombolysis, we hope that more granular data will be available in the near future.
We also thank Siegler et al. for their comment. It would be ideal to perform a matched analysis of stroke patients with premorbid disability, observing those who did or did not receive endovascular thrombectomy, but that was not possible in the TRACK registry. Nonetheless, we do feel that the outcome of no accumulated disability is a valid endpoint, particularly given the limitations described in our manuscript.1 Adding mRS 0-2 to our outcome, as a composite outcome, creates a bias towards the null in our opinion. Ultimately, as the indications for endovascular thrombectomy become more inclusive, we will have to test many of these subgroup hypotheses in dedicated trials—in particular, premorbid disability, distal occlusion, and low stroke severity.
Disclosure
The author reports no relevant disclosures. Contact journal@neurology.org for full disclosures.
References