title: Endovascular treatment improves cognition after stroke: A secondary analysis of REVASCAT trial.
abstract: OBJECTIVE
  To investigate the effect of endovascular treatment on cognitive function as a prespecified secondary analysis of the REVASCAT (Endovascular Revascularization With Solitaire Device Versus Best Medical Therapy in Anterior Circulation Stroke Within 8 Hours) trial.
  
  
  METHODS
  REVASCAT randomized 206 patients with anterior circulation proximal arterial occlusion stroke to Solitaire thrombectomy or best medical treatment alone. Patients with established dementia were excluded from enrollment. Cognitive function was assessed in person with Trail Making Test (TMT) Parts A and B at 3 months and 1 year after randomization by an investigator masked to treatment allocation. Test completion within 5 minutes, time of completion (seconds), and number of errors were recorded.
  
  
  RESULTS
  From November 2012 to December 2014, 206 patients were enrolled in REVASCAT. TMT was assessed in 82 of 84 patients undergoing thrombectomy and 86 of 87 control patients alive at 3 months and in 71 of 79 patients undergoing thrombectomy and 72 of 78 control patients alive at 1 year. Rates of timely TMT-A completion were similar in both treatment arms, although patients undergoing thrombectomy required less time for TMT-A completion and had higher rates of error-free TMT-A performance. Thrombectomy was also associated with a higher probability of timely TMT-B completion (adjusted odds ratio 3.17, 95% confidence interval 1.51-6.66 at 3 months; and adjusted ratio 3.66, 95% confidence interval 1.60-8.35 at 1 year) and shorter time for TMT-B completion. Differences in TMT completion times between treatment arms were significant in patients with good functional outcome but not in those who were functionally dependent (modified Rankin Scale score >2). Poorer cognitive outcomes were significantly associated with larger infarct volume, higher modified Rankin Scale scores, and worse quality of life.
  
  
  CONCLUSIONS
  Thrombectomy improves TMT performance after stroke, especially among patients who reach good functional recovery.
  
  
  BACKGROUND
  NCT01692379.
  
  
  METHODS
  This study provides Class I evidence that for patients with stroke from acute anterior circulation proximal arterial occlusion, thrombectomy improves performance on the TMT at 3 months.
authors.affiliation: From the Department of Neuroscience (E.L.-C., M.J., M.G., M.H.-P., C.C., A.D.), Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain; Stroke Institute (T.G.J.), Department of Neurology, UPMC, Pittsburgh, PA; Statistics and Operations Research (E.C.), Barcelona-Tech; Bioclever (N.C.), Department of Statistics; Hospital de Bellvitge (P.C., B.L.), L'Hospitalet de Llobregat; Hospital Clínic i Provincial (A.R., L.L.); and Hospital Vall d'Hebron (S.B., M.M.), Barcelona, Spain. elenacancio@gmail.com.
authors.forename: Elena
authors.initials: E
authors.lastname: López-Cancio
authors.affiliation: From the Department of Neuroscience (E.L.-C., M.J., M.G., M.H.-P., C.C., A.D.), Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain; Stroke Institute (T.G.J.), Department of Neurology, UPMC, Pittsburgh, PA; Statistics and Operations Research (E.C.), Barcelona-Tech; Bioclever (N.C.), Department of Statistics; Hospital de Bellvitge (P.C., B.L.), L'Hospitalet de Llobregat; Hospital Clínic i Provincial (A.R., L.L.); and Hospital Vall d'Hebron (S.B., M.M.), Barcelona, Spain.
authors.forename: Tudor G
authors.initials: TG
authors.lastname: Jovin
authors.affiliation: From the Department of Neuroscience (E.L.-C., M.J., M.G., M.H.-P., C.C., A.D.), Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain; Stroke Institute (T.G.J.), Department of Neurology, UPMC, Pittsburgh, PA; Statistics and Operations Research (E.C.), Barcelona-Tech; Bioclever (N.C.), Department of Statistics; Hospital de Bellvitge (P.C., B.L.), L'Hospitalet de Llobregat; Hospital Clínic i Provincial (A.R., L.L.); and Hospital Vall d'Hebron (S.B., M.M.), Barcelona, Spain.
authors.forename: Erik
authors.initials: E
authors.lastname: Cobo
authors.affiliation: From the Department of Neuroscience (E.L.-C., M.J., M.G., M.H.-P., C.C., A.D.), Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain; Stroke Institute (T.G.J.), Department of Neurology, UPMC, Pittsburgh, PA; Statistics and Operations Research (E.C.), Barcelona-Tech; Bioclever (N.C.), Department of Statistics; Hospital de Bellvitge (P.C., B.L.), L'Hospitalet de Llobregat; Hospital Clínic i Provincial (A.R., L.L.); and Hospital Vall d'Hebron (S.B., M.M.), Barcelona, Spain.
authors.forename: Neus
authors.initials: N
authors.lastname: Cerdá
authors.affiliation: From the Department of Neuroscience (E.L.-C., M.J., M.G., M.H.-P., C.C., A.D.), Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain; Stroke Institute (T.G.J.), Department of Neurology, UPMC, Pittsburgh, PA; Statistics and Operations Research (E.C.), Barcelona-Tech; Bioclever (N.C.), Department of Statistics; Hospital de Bellvitge (P.C., B.L.), L'Hospitalet de Llobregat; Hospital Clínic i Provincial (A.R., L.L.); and Hospital Vall d'Hebron (S.B., M.M.), Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Jiménez
authors.affiliation: From the Department of Neuroscience (E.L.-C., M.J., M.G., M.H.-P., C.C., A.D.), Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain; Stroke Institute (T.G.J.), Department of Neurology, UPMC, Pittsburgh, PA; Statistics and Operations Research (E.C.), Barcelona-Tech; Bioclever (N.C.), Department of Statistics; Hospital de Bellvitge (P.C., B.L.), L'Hospitalet de Llobregat; Hospital Clínic i Provincial (A.R., L.L.); and Hospital Vall d'Hebron (S.B., M.M.), Barcelona, Spain.
authors.forename: Meritxell
authors.initials: M
authors.lastname: Gomis
authors.affiliation: From the Department of Neuroscience (E.L.-C., M.J., M.G., M.H.-P., C.C., A.D.), Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain; Stroke Institute (T.G.J.), Department of Neurology, UPMC, Pittsburgh, PA; Statistics and Operations Research (E.C.), Barcelona-Tech; Bioclever (N.C.), Department of Statistics; Hospital de Bellvitge (P.C., B.L.), L'Hospitalet de Llobregat; Hospital Clínic i Provincial (A.R., L.L.); and Hospital Vall d'Hebron (S.B., M.M.), Barcelona, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Hernández-Pérez
authors.affiliation: From the Department of Neuroscience (E.L.-C., M.J., M.G., M.H.-P., C.C., A.D.), Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain; Stroke Institute (T.G.J.), Department of Neurology, UPMC, Pittsburgh, PA; Statistics and Operations Research (E.C.), Barcelona-Tech; Bioclever (N.C.), Department of Statistics; Hospital de Bellvitge (P.C., B.L.), L'Hospitalet de Llobregat; Hospital Clínic i Provincial (A.R., L.L.); and Hospital Vall d'Hebron (S.B., M.M.), Barcelona, Spain.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Cáceres
authors.affiliation: From the Department of Neuroscience (E.L.-C., M.J., M.G., M.H.-P., C.C., A.D.), Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain; Stroke Institute (T.G.J.), Department of Neurology, UPMC, Pittsburgh, PA; Statistics and Operations Research (E.C.), Barcelona-Tech; Bioclever (N.C.), Department of Statistics; Hospital de Bellvitge (P.C., B.L.), L'Hospitalet de Llobregat; Hospital Clínic i Provincial (A.R., L.L.); and Hospital Vall d'Hebron (S.B., M.M.), Barcelona, Spain.
authors.forename: Pere
authors.initials: P
authors.lastname: Cardona
authors.affiliation: From the Department of Neuroscience (E.L.-C., M.J., M.G., M.H.-P., C.C., A.D.), Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain; Stroke Institute (T.G.J.), Department of Neurology, UPMC, Pittsburgh, PA; Statistics and Operations Research (E.C.), Barcelona-Tech; Bioclever (N.C.), Department of Statistics; Hospital de Bellvitge (P.C., B.L.), L'Hospitalet de Llobregat; Hospital Clínic i Provincial (A.R., L.L.); and Hospital Vall d'Hebron (S.B., M.M.), Barcelona, Spain.
authors.forename: Blanca
authors.initials: B
authors.lastname: Lara
authors.affiliation: From the Department of Neuroscience (E.L.-C., M.J., M.G., M.H.-P., C.C., A.D.), Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain; Stroke Institute (T.G.J.), Department of Neurology, UPMC, Pittsburgh, PA; Statistics and Operations Research (E.C.), Barcelona-Tech; Bioclever (N.C.), Department of Statistics; Hospital de Bellvitge (P.C., B.L.), L'Hospitalet de Llobregat; Hospital Clínic i Provincial (A.R., L.L.); and Hospital Vall d'Hebron (S.B., M.M.), Barcelona, Spain.
authors.forename: Arturo
authors.initials: A
authors.lastname: Renú
authors.affiliation: From the Department of Neuroscience (E.L.-C., M.J., M.G., M.H.-P., C.C., A.D.), Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain; Stroke Institute (T.G.J.), Department of Neurology, UPMC, Pittsburgh, PA; Statistics and Operations Research (E.C.), Barcelona-Tech; Bioclever (N.C.), Department of Statistics; Hospital de Bellvitge (P.C., B.L.), L'Hospitalet de Llobregat; Hospital Clínic i Provincial (A.R., L.L.); and Hospital Vall d'Hebron (S.B., M.M.), Barcelona, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Llull
authors.affiliation: From the Department of Neuroscience (E.L.-C., M.J., M.G., M.H.-P., C.C., A.D.), Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain; Stroke Institute (T.G.J.), Department of Neurology, UPMC, Pittsburgh, PA; Statistics and Operations Research (E.C.), Barcelona-Tech; Bioclever (N.C.), Department of Statistics; Hospital de Bellvitge (P.C., B.L.), L'Hospitalet de Llobregat; Hospital Clínic i Provincial (A.R., L.L.); and Hospital Vall d'Hebron (S.B., M.M.), Barcelona, Spain.
authors.forename: Sandra
authors.initials: S
authors.lastname: Boned
authors.affiliation: From the Department of Neuroscience (E.L.-C., M.J., M.G., M.H.-P., C.C., A.D.), Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain; Stroke Institute (T.G.J.), Department of Neurology, UPMC, Pittsburgh, PA; Statistics and Operations Research (E.C.), Barcelona-Tech; Bioclever (N.C.), Department of Statistics; Hospital de Bellvitge (P.C., B.L.), L'Hospitalet de Llobregat; Hospital Clínic i Provincial (A.R., L.L.); and Hospital Vall d'Hebron (S.B., M.M.), Barcelona, Spain.
authors.forename: Marian
authors.initials: M
authors.lastname: Muchada
authors.affiliation: From the Department of Neuroscience (E.L.-C., M.J., M.G., M.H.-P., C.C., A.D.), Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain; Stroke Institute (T.G.J.), Department of Neurology, UPMC, Pittsburgh, PA; Statistics and Operations Research (E.C.), Barcelona-Tech; Bioclever (N.C.), Department of Statistics; Hospital de Bellvitge (P.C., B.L.), L'Hospitalet de Llobregat; Hospital Clínic i Provincial (A.R., L.L.); and Hospital Vall d'Hebron (S.B., M.M.), Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Dávalos
mesh_terms: D020520:Brain Infarction / Q000000981:diagnostic imaging / Q000209:etiology; D003072:Cognition Disorders / Q000209:etiology* / Q000628:therapy*; D057510:Endovascular Procedures / Q000379:methods*; D056344:Executive Function; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D013030:Spain; D020521:Stroke / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy*; D017131:Thrombectomy / Q000379:methods*