Impact of socioeconomic deprivation on mechanical thrombectomy outcomes after acute ischaemic stroke: findings from a London-based multicentre study
Background Mechanical thrombectomy (MT) improves outcomes in patients who had an acute ischaemic stroke due to large vessel occlusion (LVO). However, socioeconomic status (SES) can influence recovery and prognosis. This study investigated the effect of SES, assessed via the Index of Multiple Depriva...
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| Language: | English |
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BMJ Publishing Group
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| Series: | Stroke and Vascular Neurology |
| Online Access: | https://svn.bmj.com/content/early/2025/04/23/svn-2024-003915.full |
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| author | Robert Simister Viva Levee Matthew Fallon Soma Banerjee Fahad Sheikh Liqun Zhang Lucio D’Anna Tsering Dolkar Katherine Chulack Feras Fayez Nina Mansoor Adelaida Gartner |
| author_facet | Robert Simister Viva Levee Matthew Fallon Soma Banerjee Fahad Sheikh Liqun Zhang Lucio D’Anna Tsering Dolkar Katherine Chulack Feras Fayez Nina Mansoor Adelaida Gartner |
| author_sort | Robert Simister |
| collection | DOAJ |
| description | Background Mechanical thrombectomy (MT) improves outcomes in patients who had an acute ischaemic stroke due to large vessel occlusion (LVO). However, socioeconomic status (SES) can influence recovery and prognosis. This study investigated the effect of SES, assessed via the Index of Multiple Deprivation (IMD), on MT outcomes in a multicentre London cohort.Methods This retrospective study included patients with anterior circulation LVO treated with MT between 2021 and 2023 at three London hospitals. Patients were grouped into IMD1–5 (more deprived) and IMD6–10 (less deprived). Inverse probability weighting balanced baseline characteristics. Primary outcomes were 90-day functional independence (modified Rankin Scale (mRS) 0–2) and 90-day mRS shift. Secondary outcomes included recanalisation, early neurological changes, 90-day mortality, symptomatic intracerebral haemorrhage (sICH) and haemorrhagic transformation (HT). Subgroup analyses explored interactions between IMD and demographic or clinical factors. LASSO (Least Absolute Shrinkage and Selection Operator) regression identified predictors of functional independence, while receiver operating characteristic analysis evaluated IMD’s predictive value.Results Among 1219 patients with acute LVO ischemic stroke treated with MT, 533 (43.7%) were in IMD1–5 and 686 (56.3%) in IMD6–10. IMD1–5 patients had lower odds of functional independence at 90 days (RR 0.79, 95% CI 0.70 to 0.90) and worse mRS shift (OR 1.29, 95% CI 1.06 to 1.58). They also had higher risks of sICH (RR 2.07, 95% CI 1.54 to 2.67) and HT (Risk Ratio 1.47, 95% CI 1.21 to 1.80). Subgroup analysis highlighted IMD’s predictive importance in Asian or mixed ethnicity groups. A model incorporating IMD, age, sex, hypertension and National Institutes of Health Stroke Scale (area under the curve 0.656) demonstrated predictive accuracy for 90-day functional independence.Conclusions Lower SES correlates with worse outcomes and higher complications post-MT, even within a universal healthcare system. Addressing SES disparities could improve stroke care equity. |
| format | Article |
| id | doaj-art-7bbc4a06cc734140802402f5b91eba2f |
| institution | OA Journals |
| issn | 2059-8696 |
| language | English |
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| series | Stroke and Vascular Neurology |
| spelling | doaj-art-7bbc4a06cc734140802402f5b91eba2f2025-08-20T02:10:50ZengBMJ Publishing GroupStroke and Vascular Neurology2059-869610.1136/svn-2024-003915Impact of socioeconomic deprivation on mechanical thrombectomy outcomes after acute ischaemic stroke: findings from a London-based multicentre studyRobert Simister0Viva Levee1Matthew Fallon2Soma Banerjee3Fahad Sheikh4Liqun Zhang5Lucio D’Anna6Tsering Dolkar7Katherine Chulack8Feras Fayez9Nina Mansoor10Adelaida Gartner11The National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, UKImperial College Healthcare NHS Trust, London, UKNeuroradiology, St George`s University Hospitals NHS Foundation Trust, London, UKDivision of Brain Sciences, Imperial College London, London, UKYorkshire and Humber Gastroenterology Udit and research Trainee network (YHGT)St George’s Healthcare NHS Trust, London, UKImperial College London, London, UKHospital Medicine, University of Kentucky, Lexington, Kentucky, USADepartment of Stroke & Neurosciences, Imperial College Healthcare NHS Trust, London, London, UKImperial College Healthcare NHS Trust, London, UKDepartment of Neuroradiology, St George’s University of London, London, UKDepartment of Neurology, St George’s University of London, London, UKBackground Mechanical thrombectomy (MT) improves outcomes in patients who had an acute ischaemic stroke due to large vessel occlusion (LVO). However, socioeconomic status (SES) can influence recovery and prognosis. This study investigated the effect of SES, assessed via the Index of Multiple Deprivation (IMD), on MT outcomes in a multicentre London cohort.Methods This retrospective study included patients with anterior circulation LVO treated with MT between 2021 and 2023 at three London hospitals. Patients were grouped into IMD1–5 (more deprived) and IMD6–10 (less deprived). Inverse probability weighting balanced baseline characteristics. Primary outcomes were 90-day functional independence (modified Rankin Scale (mRS) 0–2) and 90-day mRS shift. Secondary outcomes included recanalisation, early neurological changes, 90-day mortality, symptomatic intracerebral haemorrhage (sICH) and haemorrhagic transformation (HT). Subgroup analyses explored interactions between IMD and demographic or clinical factors. LASSO (Least Absolute Shrinkage and Selection Operator) regression identified predictors of functional independence, while receiver operating characteristic analysis evaluated IMD’s predictive value.Results Among 1219 patients with acute LVO ischemic stroke treated with MT, 533 (43.7%) were in IMD1–5 and 686 (56.3%) in IMD6–10. IMD1–5 patients had lower odds of functional independence at 90 days (RR 0.79, 95% CI 0.70 to 0.90) and worse mRS shift (OR 1.29, 95% CI 1.06 to 1.58). They also had higher risks of sICH (RR 2.07, 95% CI 1.54 to 2.67) and HT (Risk Ratio 1.47, 95% CI 1.21 to 1.80). Subgroup analysis highlighted IMD’s predictive importance in Asian or mixed ethnicity groups. A model incorporating IMD, age, sex, hypertension and National Institutes of Health Stroke Scale (area under the curve 0.656) demonstrated predictive accuracy for 90-day functional independence.Conclusions Lower SES correlates with worse outcomes and higher complications post-MT, even within a universal healthcare system. Addressing SES disparities could improve stroke care equity.https://svn.bmj.com/content/early/2025/04/23/svn-2024-003915.full |
| spellingShingle | Robert Simister Viva Levee Matthew Fallon Soma Banerjee Fahad Sheikh Liqun Zhang Lucio D’Anna Tsering Dolkar Katherine Chulack Feras Fayez Nina Mansoor Adelaida Gartner Impact of socioeconomic deprivation on mechanical thrombectomy outcomes after acute ischaemic stroke: findings from a London-based multicentre study Stroke and Vascular Neurology |
| title | Impact of socioeconomic deprivation on mechanical thrombectomy outcomes after acute ischaemic stroke: findings from a London-based multicentre study |
| title_full | Impact of socioeconomic deprivation on mechanical thrombectomy outcomes after acute ischaemic stroke: findings from a London-based multicentre study |
| title_fullStr | Impact of socioeconomic deprivation on mechanical thrombectomy outcomes after acute ischaemic stroke: findings from a London-based multicentre study |
| title_full_unstemmed | Impact of socioeconomic deprivation on mechanical thrombectomy outcomes after acute ischaemic stroke: findings from a London-based multicentre study |
| title_short | Impact of socioeconomic deprivation on mechanical thrombectomy outcomes after acute ischaemic stroke: findings from a London-based multicentre study |
| title_sort | impact of socioeconomic deprivation on mechanical thrombectomy outcomes after acute ischaemic stroke findings from a london based multicentre study |
| url | https://svn.bmj.com/content/early/2025/04/23/svn-2024-003915.full |
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