Side matters: differences in functional outcome and quality of life after thrombectomy in left and right hemispheric stroke
-
Published:2022-11-21
Issue:1
Volume:4
Page:
-
ISSN:2524-3489
-
Container-title:Neurological Research and Practice
-
language:en
-
Short-container-title:Neurol. Res. Pract.
Author:
Deb-Chatterji MilaniORCID, Flottmann Fabian, Meyer Lukas, Brekenfeld Caspar, Fiehler Jens, Gerloff Christian, Thomalla Götz, Gerloff C., Fiehler J., Thomalla G., Alegiani A., Boeckh-Behrens , Wunderlich Silke, Ernemann Ulrike, Poli Sven, Siebert Eberhard, Nolte Christian H., Zweynert Sarah, Bohner Georg, Ludolph Alexander, Henn Karl-Heinz, Schäfer Jan Hendrik, Keil Fee, Röther Joachim, Eckert Bernd, Berrouschot Jörg, Bormann Albrecht, Dorn Franziska, Petzold Gabor, Kraemer Christoffer, Leischner Hannes, Trumm Christoph, Tiedt Steffen, Kellert Lars, Petersen Martina, Stögbauer Florian, Braun Michael, Hamann Gerhard F., Gröschel Klaus, Uphaus Timo, Reich Arno, Nikoubashman Omid, Schellinger Peter, Borggrefe Jan, Hattingen Jörg, Liman Jan, Ernst Marielle,
Abstract
Abstract
Background
Patients with a left (LHS) or right hemispheric stroke (RHS) differ in terms of clinical symptoms due to lateralization of specific cortical functions. Studies on functional outcome after stroke and endovascular thrombectomy (EVT) comparing both hemispheres showed conflicting results so far. The impact of stroke laterality on patient-reported health-related quality of life (HRQoL) after EVT has not yet been adequately addressed and still remains unclear.
Methods
Consecutive stroke thrombectomy patients, derived from a multi-center, prospective registry (German Stroke Registry) between June 2015 and December 2019, were included in this study. At 90 days, outcome after EVT was assessed by the modified Rankin scale (mRS) and HRQoL using the European QoL-five dimensions questionnaire utility-index (EQ-5D-I; higher values indicate better HRQoL) in patients with LHS and RHS. Adjusted regression analysis was applied to evaluate the influence of stroke laterality on outcome after EVT.
Results
In total, 5683 patients were analyzed. Of these, 2953 patients (52.8%) had LHS and 2637 (47.2%) RHS. LHS patients had a higher baseline NIHSS (16 vs. 13, p < 0.001) and a higher ASPECTS (9 vs. 8, p < 0.001) compared to RHS patients. Among survivors, patients with LHS less frequently had a self-reported affected mobility (p = 0.037), suffered less often from pain (p = 0.04) and anxiety/depression (p = 0.032) three months after EVT. After adjusting for confounders (age, sex, baseline NIHSS), LHS was associated with a better HRQoL (ß coefficient 0.04, CI 95% 0.017–0.063; p = 0.001), and better functional outcome assessed by lower values on the mRS (ß coefficient − 0.109, CI 95% − 0.217–0.000; p = 0.049).
Conclusions
Ninety days after EVT, LHS patients have a better functional outcome and HRQoL. Patients with RHS should be actively assessed and treated for pain, anxiety and depression to improve their HRQoL after EVT.
Publisher
Springer Science and Business Media LLC
Subject
Automotive Engineering
Reference24 articles.
1. Foerch, C., Misselwitz, B., Sitzer, M., Berger, K., Steinmetz, H., & Neumann-Haefelin, T. (2005). Difference in recognition of right and left hemispheric stroke. Lancet, 366, 392–393. 2. Di Legge, S., Fang, J., Saposnik, G., & Hachinski, V. (2005). The impact of lesion side on acute stroke treatment. Neurology, 65, 81–86. 3. MacHale, S. M., O’Rourke, S. J., Wardlaw, J. M., & Dennis, M. S. (1998). Depression and its relation to lesion location after stroke. Journal of Neurology, Neurosurgery and Psychiatry, 64, 371–374. 4. Fink, J. N., Selim, M. H., Kumar, S., et al. (2002). Is the association of National Institutes of Health Stroke Scale scores and acute magnetic resonance imaging stroke volume equal for patients with right-and left-hemisphere ischemic stroke? Stroke, 33, 954–958. 5. Woo, D., Broderick, J. P., Kothari, R. U., et al. (1999). Does the National Institutes of Health Stroke Scale favor left hemisphere strokes? NINDS t-PA stroke study group. Stroke, 30, 2355–2359.
Cited by
2 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献
|
|