AUTHOR=Zhang Ping , Shen Hong-jian , Chen Lei , Zhu Xuan , Zhang Min-min , Jiang Yi , Yang Peng-fei , Zhang Lei , Xing Peng-fei , Ye Xiao-fei , Lou Min , Yin Cong-guo , Deng Ben-qiang , Wu Tao , Zhang Yong-wei , Liu Jian-min 

TITLE=Patient-Reported Anxiety/Depression After Endovascular Thrombectomy: A post-hoc Analysis of Direct-MT Trial

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.811629

DOI=10.3389/fneur.2022.811629

ISSN=1664-2295

ABSTRACT=Objective: To analyze the effect of endovascular thrombectomy (EVT) alone vs. EVT after IV alteplase of ischemic stroke on patient-reported depression/anxiety and to identify predictors of patient-reported depression/anxiety by analyzing data from DIRECT-MT(Direct Intraarterial Thrombectomy in Order to Revascularize Acute Ischemic Stroke Patients with Large Vessel Occlusion Efficiently in Chinese Tertiary Hospitals: a Multicenter Randomized Clinical Trial). 
Methods: Patients with acute ischemic stroke (AIS) triggered by large-vessel occlusion in the anterior circulation were randomly allocated to undergo EVT after IV alteplase (combination-therapy group) or EVT alone (EVT-alone group) at a 1:1 ratio in DIRECT-MT. Patients who returned the 5-Dimensional European Quality of Life Scale (EQ-5D-5L) at 90 days (±14 days) post stroke were included. EQ-5D-5L anxiety/depression dimension was used to analyze the patient-reported anxiety/depression. First, differences in patient-reported anxiety/depression were compared between combination-therapy group and EVT-alone group. Then, the baseline and influencing factors between anxiety/depression group and no Anxiety/Depression Group were analyzed using univariate regression analysis. Finally, variables with p < 0.1 in univariate regression were subjected to multivariable binary regression analysis to screen independent predictors for patient-reported anxiety/depression after cerebral infraction.
Results: 515 patients returned the EQ-5D-5L in Direct-MT. Of these patients, 226 (43.88%) reported any level of anxiety/depression, and about 7% reported severe or extremely severe anxiety/depression. The patient-reported anxiety/depression in EVT-alone group was significantly higher than that in combination-therapy group (48.26% vs. 39.45%, P=0.04). The clinical outcomes were significantly different between no Anxiety/Depression Group and anxiety/depression group(mRS:2.00 vs 3.00,P=0.00; BI of 95 or 100 at 90 days:73.36%vs42.04%,P=0.00; EQ-5D-5l utility indexes at 90 days: 0.96vs0.57, P=0.00). Logistic regression analysis showed that allocation to thrombolysis before EVT strategy was inversely associated with anxiety/depression[(0.61(0.40,0.94),P=0.03],Insular cortex ischemia and NIHSS at 7 days were positively associated with anxiety/depression[2.04(1.07,3.90),P=0.03；1.07(1.03,1.12), P=0.00 ].
Conclusions: Patient-reported anxiety/depression may suggests that there is a benefit to administering intravenous alteplase before EVT. It may also indicate that it is better to provide IV alteplase before EVT rather than EVT alone according to patient-reported depression/anxiety. Future research should consider not only the motor function impairments but also patient-reported mental problems as measures of treatment efficacy in stroke patients.