Patient-reported non-motor outcomes after endovascular thrombectomy and intravenous thrombolysis: an observational study.

INTRODUCTION

Adverse non-motor outcomes dominate the lived reality of post-stroke recovery, yet remain poorly understood after intravenous thrombolysis (IVT), endovascular thrombectomy (EVT) or both. We characterised the prevalence of outcomes in 13 non-motor domains, stratified by mRS scores, and identified baseline factors associated with adverse outcomes at 6 months follow-up.

METHODS

We conducted a prospective observational sub-study within the Stroke Investigation Group in North and Central London (SIGNAL) registry to characterise non-motor outcomes after IVT, EVT or both. At 6 months, we assessed mRS alongside 13 patient-reported non-motor domains, including neuropsychiatric, fatigue, sleep, social participation, sensory, autonomic and cognitive outcomes. We used unadjusted analysis to estimate prevalence and adjusted multivariate logistic regression to investigate associated baseline factors.

RESULTS

We included 642/646 (99.3%) eligible surviving patients (median age 73 years; 43.5% female; median NIHSS = 5; mRS = 1) treated with IVT, EVT or both. At 6 months, the prevalence of adverse non-motor outcomes across 13 domains ranged from 18% to 56% across all treatment groups. Among patients with a favourable functional outcome (mRS 0-2, n = 409), fatigue (51.3%), sleep disturbance (47.6%) and mood problems (39.6%) were most prevalent. In those with an unfavourable outcome (mRS 3-5, n = 233), dependency in activities of daily living (51.0%), reduced social participation (44.3%) and bladder dysfunction (41.0%) were common. Stroke recurrence, female sex and baseline NIHSS > 5 were significantly associated with multiple adverse non-motor outcomes at 6 months.

CONCLUSION

Despite favourable mRS, a high proportion of patients treated with IVT and/or EVT report adverse non-motor outcomes. Systematic non-motor assessments alongside mRS are needed to accurately capture post-stroke symptom burden and guide person-centred life after stroke care.