No Significant Association Between PAD and Outcomes After Endovascular Thrombectomy

It remains questionable as to whether peripheral artery disease (PAD) leads to remote ischemic preconditioning (RIPC) after endovascular thrombectomy (EVT).

A team of Dutch researchers established the prospective MR CLEAN registry to compare EVT outcomes in acute stroke patients with and without PAD.

“Though PAD is a well-known risk factor for ischemic events, better outcomes have been described in acute ischemic stroke patients with co-existing PAD,” the authors wrote. “This paradoxical association has been attributed to remote ischemic preconditioning (RIPC) and might be related to better collateral blood flow.”

The investigators looked at 2,765 patients treated with EVT for an anterior large artery occlusion, of which 9.2% participants (n=254) had PAD. Collaterals were scored on a 4-point scale using computed tomography (CT) angiography. The primary outcome was the association of PAD with collateral grades and functional outcome at 90 days, assessed via the modified Rankin Scale (mRS). Other safety outcomes included mortality at 90 days, symptomatic intracranial hemorrhage, and stroke progression.

After adjustment for confounding factors, a multivariable regression analysis found no association of PAD with functional outcome (mRS cOR 0.90, 95% confidence interval [CI], 0.7–1.2), collateral grades (cOR 0.85, 95% CI 0.7–1.1), or safety outcomes. There was also no association established between PAD and other secondary outcomes.

“In summary, our study showed no association between PAD and outcome after EVT for acute ischemic stroke nor an independent association between PAD and collateral blood flow,” the authors wrote in their conclusion. “As such, we could not confirm the occurrence of RIPC in PAD patients with acute ischemic stroke. Future studies with more standardized measurement of PAD are recommended.”

The paper was published in Frontiers in Neurology.