Outcomes of patients with pre-stroke disability after acute ischemic stroke and endovascular thrombectomy

Journal article

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.

Authors: Salam, A; Butt, W; Diestro, JDB; Dmytriw, AA; Li, Y

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: BMJ Publishing Group
• Journal: Journal of NeuroInterventional Surgery
• Pages: jnis-2026-025017
• Article number: jnis-2026-025017
• Publication date: 2026-03-27
• Acceptance date: 2026-03-09
• DOI: 10.1136/jnis-2026-025017
• EISSN: 1759-8486
• ISSN: 1759-8478
• Language: English
• Keywords: Thrombectomy; Stroke; CT Angiography; Thrombolysis; Reperfusion