Introduction: Long-term skilled nursing facility residents tend to have multiple medical comorbidities and typically require assistance with routine activities of daily living. Mechanical thrombectomy (MT) clinical trials have previously excluded patients with compromised baseline functional status (mRS >2), including SNF residents. To study this underrepresented population, we examine outcomes following mechanical thrombectomy.
Methods: Between July 2014 and August 2017, 243 patients underwent MT at our facility. Of these, 27 were long term SNF residents. Demographics, risk factors, treatment modalities, imaging and clinical outcomes were abstracted from a prospectively maintained database. Favorable outcome is defined as either an improvement or return to baseline functional status, assessed by mRS at 90 days.
Results: Of the 27 SNF patients, 17 (63%) were female. The median age of this cohort was 84 (IQR 79-89) and the median baseline mRS was 4 (IQR 3-4). Successful TICI 2b/3 recanalization was achieved in 92.6% (25/27). There were 5 (23.8%) patients with hemorrhagic transformation and 1 (3.7%) developed symptomatic parenchymal hemorrhage. Overall, 7 patients (25.9%) had either improved by 1 point decrement in baseline mRS (N=3) or returned to baseline functional status (N=4). Another 10 (37%) were dead at 90 days. Higher baseline ASPECT score was a predictor of favorable outcome.
Conclusions: Advanced age and premorbid baseline disability are established predictors of poor outcome in stroke patients. However, redefining favorable outcome to include return to baseline functioning demonstrates that up to one-fourth of patients in this population may benefit from MT.
Patient Care: There are very limited studies looking at the populations of patients that reside in nursing homes. This includes patients with advanced age, significant comorbidities, and compromised function of daily living. By reporting the outcomes of these patients, favorable outcomes can be redefined to reveal the utility of mechanical thrombectomy in this particular population of patients. This will improve the care and approach of stroke in such patients.
Learning Objectives: To report outcomes of skilled nursing facility (SNF) residents with baseline moderate to severe disability who undergo mechanical thrombectomy (MT) for acute ischemic stroke (AIS).