Outcomes of patients with pre-stroke disability after acute ischemic stroke and endovascular thrombectomy
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Moderate to severe pre-stroke disability (modified Rankin Scale (mRS) score 3-5) is an exclusion criterion for endovascular thrombectomy (EVT) in acute ischemic stroke (AIS), yet outcomes for this group remain underexplored. METHODS: Patients who underwent EVT, dichotomized to mRS ≤2 or mRS 3-5, between October 2015 and March 2020 were included from a national stroke registry. Favorable functional outcome was defined as mRS 0-2 for the mRS ≤2 cohort or no worsening of the mRS for the mRS 3-5 cohort at hospital discharge and at 6 months. Other outcomes included in-hospital mortality, symptomatic intracranial hemorrhage (sICH), early neurological deterioration (END), and successful recanalization (modified Thrombolysis in Cerebral Infarction (mTICI) 2b-3). The effect of successful recanalization on functional outcome and predictors of favorable functional outcome was assessed in the pre-stroke mRS 3-5 group. RESULTS: Among 4353 patients included in the study, 203 (4.6%) had moderate to severe pre-stroke disability. No significant differences were found in favorable functional outcome at discharge (30.5% in mRS 3-5 group vs 33.0% in mRS 0-2 group, adjusted OR 1.21, 95% CI 0.87-1.70, P=0.25) and at 6 months (P=0.97), sICH (P=0.39), END (P=0.72), or successful recanalization (P=0.15). In-hospital mortality was higher in the pre-stroke mRS 3-5 group (P<0.009). Successful recanalization was significantly associated with favorable functional outcomes compared with no recanalization (P=0.008). Admission National Institutes of Health Stroke Scale score, onset to arterial puncture time, EVT technique, and successful recanalization independently predicted functional outcome among patients with pre-stroke mRS 3-5. CONCLUSION: Moderate to severe pre-stroke disability was comparable to pre-stroke mRS 0-2 with respect to favorable functional outcomes after EVT, and may not be a justified exclusion criterion for EVT in AIS. Randomized studies are necessary to optimize decision-making and evaluate the broader impact of EVT in this population.
Institutions: University of Nottingham, University Hospitals Birmingham NHS Foundation Trust, St. Michael's Hospital, University of Toronto, Brigham and Women's Hospital, Harvard University, University of Oxford, Massachusetts General Hospital, Toronto Metropolitan University, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, University of Hong Kong, King's College London, King's College Hospital NHS Foundation Trust, King's College Hospital, University of Dundee, Nottingham University Hospitals NHS Trust, Barts Health NHS Trust, Royal London Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Nottingham Biomedical Research Centre, Gold Coast Hospital
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7140977078