Systemic Comorbidities as Modifiers of Outcome After Endovascular Thrombectomy for Acute Ischemic Stroke

To evaluate the impact of systemic comorbidities on outcomes following endovascular thrombectomy (EVT) for acute ischemic stroke.

Although EVT achieves high rates of large-vessel reperfusion, clinical outcomes are significantly influenced by underlying comorbidities. Chronic hypertension impairs collateral circulation and increases the risk of cerebral edema and mortality. Diabetes mellitus is associated with reduced functional recovery and heightened hemorrhagic risk. Atrial fibrillation often leads to larger infarcts and contributes to higher unadjusted mortality. Chronic kidney disease, particularly in patients with dialysis dependence, predicts poor neurological outcomes and increased procedural complications. Active malignancy substantially elevates mortality, especially in patients with metastatic disease. Systemic comorbidities are important modifiers of outcome after EVT. While technical success rates routinely exceed 80-90%, functional recovery and survival vary significantly across patient subgroups. Meta-analyses and registry data highlight that comorbidities independently increase the risk of futile recanalization, complications, and mortality. EVT remains appropriate for medically complex patients, but optimal results require comorbidity-informed risk stratification and multidisciplinary, goal-concordant care.