Endovascular Thrombectomy in Patients With Preexisting Disability: A Review

Area of Science:

• Neurology
• Interventional Cardiology
• Public Health

Background:

• Endovascular mechanical thrombectomy (EVT) is effective for acute ischemic stroke (AIS) with large-vessel occlusion (LVO).
• Patients with preexisting disability are typically excluded from EVT trials, despite comprising a significant portion of AIS patients.
• Current EVT practices for patients with preexisting disability are heterogeneous, highlighting a need for evidence-based guidelines.

Purpose of the Study:

• To review the current literature on EVT in patients with acute ischemic stroke and preexisting disability.
• To identify key statistical considerations for analyzing EVT outcomes in this population.
• To discuss future research opportunities and challenges for improving EVT access for vulnerable stroke patients.

Main Methods:

• Narrative review of existing studies on EVT for acute ischemic stroke.
• Analysis of statistical methodologies applied in relevant clinical trials.
• Discussion of clinical practice patterns and research gaps.

Main Results:

• Landmark EVT trials excluded patients with preexisting disability, limiting treatment access for this group.
• Patients with preexisting disability experience disproportionately high accumulated disability after stroke.
• Significant variability exists in the current application of EVT for patients with prior disability.

Conclusions:

• Establishing evidence-based EVT guidelines for patients with preexisting disability is a critical priority.
• Further research is needed to understand the efficacy and safety of EVT in this understudied population.
• Addressing the needs of patients with preexisting disability can reduce stroke-related disability and societal burden.