Outcomes of patients with pre-stroke disability after acute ischemic stroke and endovascular thrombectomy
Salam, Abdul Butt, Waleed Diestro, Jose Danilo Bengzon Dmytriw, Adam A Li, Yan-Lin Booth, Thomas C Podlasek, Anna Malik, Luqman Nair, Sujit Mcconachie, Norman
Salam, Abdul
Butt, Waleed
Diestro, Jose Danilo Bengzon
Dmytriw, Adam A
Li, Yan-Lin
Booth, Thomas C
Podlasek, Anna
Malik, Luqman
Nair, Sujit
Mcconachie, Norman
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.
MIDER Authors
Date
2026-03-27
Type
Article
Subject
Stroke, Brain ischaemia, Thrombolytic therapy, Angiography
Collections
Citation
Salam A, Butt W, Diestro JDB, Dmytriw AA, Li YL, Booth TC, Podlasek A, Malik L, Nair S, Mcconachie N, Lenthall R, Bhogal P, England TJ, Dineen RA, Dhillon PS. Outcomes of patients with pre-stroke disability after acute ischemic stroke and endovascular thrombectomy. J Neurointerv Surg. 2026 Mar 27:jnis-2026-025017. doi: 10.1136/jnis-2026-025017. Epub ahead of print.
Journal / Source Title
Journal of Neurointerventional Surgery
DOI
10.1136/jnis-2026-025017
PMID
41895849
Publisher
BMJ Publishing Group
Publisher’s URL
https://jnis.bmj.com/