Impact of reperfusion on thrombectomy outcomes in patients with pre-stroke disability

Mechanical thrombectomy (MT) is frequently performed beyond traditional eligibility criteria, yet the clinical benefits for patients with pre-stroke disability remain uncertain.

We conducted a retrospective multicenter cohort study of patients undergoing MT for anterior circulation large-vessel occlusion stroke across a spectrum of baseline disability (modified Rankin Scale [mRS] 0-4). The primary analysis evaluated the impact of reperfusion success and the 90-day mRS shift within each baseline mRS stratum using ordinal logistic regression adjusted for age, NIHSS, ASPECTS, and occlusion site. Secondary analyses assessed discharge mRS, the effect of first-pass effect (FPE), and whether the etiology of pre-stroke disability modified outcomes.

Among 4,840 MT patients, 1,457 (30.1%) had pre-stroke disability (mRS 1-4), with considerable variation in selection practices across centers. In adjusted models, successful reperfusion showed significantly greater odds of improved 90-day mRS for patients with baseline mRS 0-3, with a similar directional benefit in those with mRS 4. No significant interaction between reperfusion and baseline disability regards 90-day mRS was detected (p = 0.12). Successful reperfusion was also associated with lower discharge mRS across all baseline strata. FPE yielded consistent clinical benefit irrespective of pre-stroke disability level. Outcomes were comparable between patients with neurological versus non-neurological sources of disability.

Successful reperfusion was linked to improved functional outcomes across a wide range of pre-stroke disability levels. Disability etiology did not significantly modify treatment benefits. These findings may support considering MT to appropriately selected patients with baseline disability. Further studies are warranted.