Endovascular treatment in acute ischemic stroke patients with pre-stroke disability: A systematic review and meta-analysis
Year: 2026
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: This meta-analysis investigated endovascular thrombectomy (EVT) efficacy and safety versus best medical treatment (BMT), including intravenous thrombolysis or other treatments when applicable, in acute ischemic stroke (AIS) patients with pre-stroke disability (mRS >2), a group frequently excluded from large vessel occlusion trials. Following PRISMA 2020 guidelines, systematic searches of PubMed, Cochrane Central, Web of Science, Scopus, and Embase databases (inception-July 2025) identified English studies (≥4 patients) comparing EVT versus BMT. Data on all-cause mortality, return to baseline mRS, and symptomatic intracranial hemorrhage (sICH) were extracted. OR with 95% CI was estimated via a random-effects model. Five studies (1400 patients; 897 EVT and 503 BMT) with pre-stroke mRS 2–4 were included. EVT significantly reduced all-cause mortality (OR: 0.49, 95% CI: 0.29–0.82, p = .007), demonstrating moderate heterogeneity (I 2 = 66.9%). It also improved return to baseline mRS (OR: 3.21, 95% CI: 2.02–6.09, p < .001) with negligible heterogeneity (I 2 = 0%). sICH was more frequent in EVT (OR: 2.24, 95% CI: 0.84–5.94) but not statistically significant ( p = .11). EVT offers survival benefits and increased return to baseline functional status for AIS patients with pre-stroke disability, without definitively increasing sICH. Prospective studies are crucial for informing inclusive clinical guidelines.
Source: The Neuroradiology Journal
Authors: Lucca Tamara Alves Carretta, Mariana Letícia de Bastos Maximiano, Rudolfh Batista Arend, Henrique Padilha Gnoatto, Rafael Torres Fonseca dos Santos, Filipe Virgilio Ribeiro, Ocilio Ribeiro Gonçalves, Beatriz Gonçalves da Silva Miroski Gerente, Nicole Baptista de Oliveira, Tassiane Cristina Morais, Fernando Rocha Oliveira, Leandro de Assis Barbosa, Ahmet Günkan
Institutions: Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória, Universidade Federal Fluminense, Universidade Federal da Fronteira Sul, Centro Universitário Barão de Mauá, Universidade Federal do Piauí, Universidade do Sul de Santa Catarina, Hospital Estadual Centra, University of Arizona
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7128611242