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Updated: Apr 13, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Treatment-modifying effects of frailty on stroke reperfusion therapy outcomes: a systematic review and meta-analysis
Anakha Varma1, Shiv Bhakta1, Esmee Dohle1
1Department of Clinical Neurosciences, University of Cambridge, Cambridge, England, United Kingdom of Great Britain and Northern Ireland.
Background:
Frailty is common amongst individuals presenting with acute ischaemic stroke (AIS). Not only has frailty been found to have disease-modifying effects in terms of survival and disability after AIS, but it may also exert a treatment-modifying effect in reperfusion therapies. However, studies investigating this to date have frequently been of limited sample size, highlighting the potential for meta-analysis to definitively establish any treatment-modifying effect.
Objectives:
We investigate the effect of pre-stroke frailty on morbidity and mortality outcomes following reperfusion treatment (thrombectomy and thrombolysis) for AIS.
Methods:
A systematic review was performed according to Preferred Reporting of Items in Systematic Reviews and Meta-Analyses guidelines, via searching the EMBASE, PubMed, Scopus and Web of Science databases up to August 2025.
Results:
We identified 11 relevant studies with 194,699 participants. Overall, the prevalence of frailty was 37.2% [frail (n = 72,311), non-frail (122,096)]. Frailty was associated with increased 90-day (RR 2.19 [95% CI 1.44-3.34]) and one-year mortality (RR 2.11 [95% CI 1.6-2.78]), but not with symptomatic intracranial haemorrhage (RR 1.23 [95% CI 0.78-1.96]) or modified Rankin score 3-5 (RR 2.20 [0.94-5.16]).
Conclusions:
Frailty has a consistent association with mortality at different time points after AIS reperfusion therapies. Despite some study heterogeneity, there is evidence that pre-stroke frailty is associated with increased mortality after treatment, though not with increased risks of symptomatic intracerebral haemorrhage or post-stroke disability. These findings suggest that routine pre-morbid frailty assessment may inform the decision-making process for AIS reperfusion treatment administration. This study highlights the need for large multi-centre prospective trials.
