Frontiers in neurology · 2026
Health-related quality of life after direct endovascular thrombectomy and bridging therapy: findings of DIRECT-MT trial.
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Gu Renjun, Huyan Meihua, Zhang Hongjian, Shen Fang, Shen Hongjian, Li Zifu, Xing Pengfei, Hua Weilong, Zhang Yongxin, Liu Jianmin, Yang Pengfei, Zhang Lei, Zhang Yongwei
Аннотация
BACKGROUND: Endovascular thrombectomy (EVT) alone is noninferior to bridging therapy for functional outcomes after large-vessel occlusion stroke in patients directly admitted to comprehensive stroke centers, but effects on health-related quality of life (HRQoL) are uncertain. We compared HRQoL between treatment strategies and assessed effect modification by baseline severity and functional outcomes strata.
METHODS: This secondary analysis of the DIRECT-MT trial compared EVT alone with bridging therapy. HRQoL at 90 days was measured by EQ-5D-5L index. Quantile regression tested treatment effects on median EQ-5D with interaction terms for baseline NIHSS categories (0-15, 16-20, 21-42) and exploratory 90-day BI and mRS strata. EQ-5D dimensions were analyzed using logistic regression for symptom-free status.
RESULTS: Among 656 patients (327 EVT alone; 329 bridging), overall HRQoL among 90-day survivors was similar between groups (median EQ-5D 0.84 vs. 0.85). Baseline stroke severity modified the treatment-EQ-5D association (P for interaction = 0.038), with bridging therapy associated with higher EQ-5D among patients with moderate-to-severe stroke (NIHSS 16-20) and severe stroke (NIHSS 21-42). In exploratory post-randomization analyses, bridging therapy was favored among patients with near-complete independence (BI 91-100; coefficient -0.056; 95% CI -0.112 to -0.001), whereas EVT alone was associated with lower EQ-5D among those with a favorable functional outcome (mRS 0-2; coefficient -0.026; 95% CI -0.044 to -0.009). In dimension-level analyses, EVT alone was associated with lower odds of symptom-free Mobility and Usual activities in the near-independent group (BI 91-100), and a treatment-by-baseline severity interaction was observed for Anxiety/depression (P for interaction = 0.018).
CONCLUSIONS: HRQoL at 90 days was comparable overall between strategies, but differed by baseline stroke severity. Exploratory analyses suggested additional heterogeneity across achieved functional states and EQ-5D dimensions, supporting further evaluation of baseline severity-guided approaches to optimize patient-centered outcomes.
METHODS: This secondary analysis of the DIRECT-MT trial compared EVT alone with bridging therapy. HRQoL at 90 days was measured by EQ-5D-5L index. Quantile regression tested treatment effects on median EQ-5D with interaction terms for baseline NIHSS categories (0-15, 16-20, 21-42) and exploratory 90-day BI and mRS strata. EQ-5D dimensions were analyzed using logistic regression for symptom-free status.
RESULTS: Among 656 patients (327 EVT alone; 329 bridging), overall HRQoL among 90-day survivors was similar between groups (median EQ-5D 0.84 vs. 0.85). Baseline stroke severity modified the treatment-EQ-5D association (P for interaction = 0.038), with bridging therapy associated with higher EQ-5D among patients with moderate-to-severe stroke (NIHSS 16-20) and severe stroke (NIHSS 21-42). In exploratory post-randomization analyses, bridging therapy was favored among patients with near-complete independence (BI 91-100; coefficient -0.056; 95% CI -0.112 to -0.001), whereas EVT alone was associated with lower EQ-5D among those with a favorable functional outcome (mRS 0-2; coefficient -0.026; 95% CI -0.044 to -0.009). In dimension-level analyses, EVT alone was associated with lower odds of symptom-free Mobility and Usual activities in the near-independent group (BI 91-100), and a treatment-by-baseline severity interaction was observed for Anxiety/depression (P for interaction = 0.018).
CONCLUSIONS: HRQoL at 90 days was comparable overall between strategies, but differed by baseline stroke severity. Exploratory analyses suggested additional heterogeneity across achieved functional states and EQ-5D dimensions, supporting further evaluation of baseline severity-guided approaches to optimize patient-centered outcomes.