Raffaele Ornello, MD
International Stroke Conference 2021
March 17–19, 2021
Joundi RA, Rebchuk AD, Field TS, Smith EE, Goyal M, Demchuk A, Dowlatshahi D, Poppe AY, Williams DJ, Mandzia JL, et al. Health-Related Quality of Life Among Patients With Acute Ischemic Stroke and Large Vessel Occlusion in the ESCAPE Trial. Stroke. 2021.
Measuring modified Rankin scale (mRS) scores 90 days after endovascular treatment (EVT) has become the mainstay of any trial on the acute phase of ischemic stroke. mRS is easy to assess and gives a clear idea of post-stroke dependency; however, it does not encompass all the dimensions of quality of life.
To fill in the gap of knowledge about health-related quality of life after EVT for ischemic stroke, the ESCAPE trial investigators randomized 315 patients to EVT or no EVT. Outcomes assessed at 90 days included mRS scores and the EuroQol-5D (EQ-5D) for quality of life. Compared with patients not receiving EVT, those receiving EVT had better mRS and EQ-5D scores at 90 days from stroke onset. In detail, the improvement was related to self-care, usual activities, mobility — only for those aged 60-79 years — and pain/discomfort — for women — while there was no association with anxiety/depression.
It is important to note that in the elderly, the improvement in quality of life was strongly influenced by the decrease in stroke-related deaths due to EVT. Nevertheless, the ESCAPE trial provides reliable proof that EVT improves overall quality of life, and not the sole dimension of disability, in patients with ischemic stroke.