Patients with moderate-to-severe disabilities before a stroke are often excluded from endovascular thrombectomy, despite making up a significant portion of those with large vessel occlusion stroke. New research presented at the Society of NeuroInterventional Surgery's 23rd Annual Meeting on July 20 suggests that carefully selected patients with pre-existing disabilities may still benefit from the procedure. Researchers found that successful restoration of blood flow was linked to less functional decline, greater odds of improvement from baseline, and lower mortality among these patients.
The study, titled "Impact of Successful Reperfusion on Functional Outcomes After Thrombectomy in Patients with Pre-stroke Disability," analyzed data from 781 patients who had pre-existing disabilities and underwent endovascular thrombectomy for large vessel occlusion stroke between 2016 and 2025 through the international Stroke Thrombectomy and Aneurysm Registry.
Researchers compared outcomes for patients who achieved successful reperfusion—restoration of blood flow to the affected area—with those who did not. Patients who experienced successful reperfusion were less likely to have worsening disability (62.2% vs. 79.6%) and had a lower chance of dying within 90 days after their stroke (39.8% vs. 57.7%). Successful reperfusion was also associated with fewer procedural complications, while rates of symptomatic brain bleeding were similar between groups.
"Patients with a disability before their stroke have been considered ineligible for thrombectomy on the assumption they have too little to gain," said Ali Alawieh, MD, PhD, senior author of the study and co-founder of the registry. "When we measured recovery against each patient's own baseline, they held onto their function comparable to patients who were independent before their stroke. Pre-existing disability alone shouldn't close the door on treatment," .
The researchers also compared outcomes for those with pre-existing disability to individuals who had little or no disability prior to their strokes. While overall outcomes and mortality were poorer among those already disabled before their strokes, researchers found that meaningful functional benefits could still be achieved if blood flow was successfully restored.
"Every patient deserves the opportunity to be considered for the treatment most likely to help them recover from a stroke," said Ali Tfaily, MS, Doctoral Fellow at Emory University Laney Graduate School and primary author of the study. "Our findings suggest that carefully selected patients with pre-stroke disability can benefit from thrombectomy and that successful restoration of blood flow may help preserve independence, improve outcomes and reduce the risk of death after stroke."
