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Updated: May 12, 2026
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Impact of Severe Prestroke Disability on Outcomes After Mechanical Thrombectomy: A Multicenter Analysis
Hannah Asperger1,2, Felix Bode1, Taraneh Ebrahimi1,2
1Department of Vascular Neurology (H.A., F.B., T.E., C.K., J.L., J.N.M., L.N., O.S., C.T., N.M.v.D., J.W., G.C.P., S.S.), University Hospital Bonn, Germany.
Background:
Patients with severe prestroke disability (PSD) remain underrepresented in mechanical thrombectomy studies, despite their growing relevance in aging populations. This study used data from the German Stroke Registry-Endovascular Treatment to evaluate functional recovery, mortality, and poststroke care outcomes in this high-risk population.
Methods:
We analyzed 9456 mechanical thrombectomy-treated patients with stroke from the German Stroke Registry-Endovascular Treatment (2015-2021), categorized by premorbid modified Rankin Scale (mRS): no PSD (mRS score, 0-1), moderate PSD (mPSD; mRS score, 2-3), and severe PSD (sPSD; mRS score, 4-5). Favorable outcomes were defined as an mRS score of 0 to 2 or return to baseline. Logistic regression adjusted for age, National Institutes of Health Stroke Scale, intravenous thrombolysis, reperfusion success, and sex was used to predict outcomes. A neural network subsequently explored feature importance.
Results:
Among 9456 patients, 7387 had no PSD, 1648 mPSD, and 421 sPSD. Unadjusted 90-day outcomes showed increasing mortality with PSD severity and fewer favorable outcomes in both PSD groups. At 90 days, favorable outcomes occurred in 3020 patients without PSD (40.9%), 232 with mPSD (14.1%), and 85 with sPSD (20.2%). After adjustment, only mPSD was associated with lower odds of favorable outcomes, while both mPSD and sPSD remained independent predictors of higher mortality. Complication rates were similar across groups, except for higher vasospasm in patients without PSD. Including rebalanced sPSD samples in predictive models resulted in minor performance improvements but notable shifts in feature importance, with age and Alberta Stroke Program Early Computed Tomography Score emerging as key predictors, National Institutes of Health Stroke Scale decreasing in relevance, and factors such as local anesthesia and occlusion location becoming more prominent.
Conclusions:
Despite higher mortality, approximately a fifth of patients with PSD achieved favorable outcomes, suggesting that this group should not be routinely excluded from mechanical thrombectomy. Further studies should refine patient selection criteria and outcome definitions for this vulnerable population.
Registration:
URL: https://www.clinicaltrials.gov; Unique identifier: NCT03356392.
