Stroke: What factors determine the prognosis of disabled patients and thrombectomy treatment after stroke?

Mechanical thrombectomy (MT) has been shown to be an effective treatment for anterior large vessel occlusion in patients with ischemic stroke .
Since the results of major clinical trials were announced in 2015, it has been widely used in Comprehensive Stroke Centers (CSCs) worldwide, including some patients with existing disabilities .

However, due to concerns about poor results and potentially useless causes, stroke patients with pre-disability are excluded from randomized clinical trials regardless of the cause of the disability
.

So far, data on the clinical response of MT in patients with poor pre-stroke status come from a single CSC experience or observational multicenter registration, so its application in clinical practice is still controversial

In general, patients with moderate pre-stroke disability have a significantly higher mortality rate within 90 days, but compared with patients without disability, the likelihood of maintaining their functional baseline status is similar
.

As the elderly population continues to grow in developed countries, the incidence of many chronic diseases is also increasing, and disability may affect about half of people over 65
.
Nonetheless, the opportunity to return to a previous state can be very valuable to patients and caregivers, even when the risk of MT death increases

In view of the lack of ongoing randomized clinical trials of MT on patients with existing disabilities, it is difficult to obtain new data based on clinical evidence in the short term.

In this way, Mònica Millán of Hospital Germans Trias i Pujol, Spain, and others analyzed the frequency of treatment of all CSC patients with pre-existing disabilities with MT in the Catalonia region (Spain) in clinical practice for many years.
In the blinded assessment, Compared with non-disabled patients, the safety and clinical response of the original disabled patients to MT, as well as the characteristics of disabled patients that are better related to MT response, in order to improve patient selection for this still unproven indication

They studied all consecutive patients with anterior circulatory occlusion enrolled in Codi Ictus Catalunya from January 2017 to December 2019, which is a government-authorized, prospective, hospital-based data set
.
Disability before stroke was defined as a modified Rankin scale score of 2 or 3

Among the 2487 patients included in the study, 409 (17.
1%) had pre-stroke disability (313 with modified Rankin scale score of 2 and 96 with modified Rankin scale score of 3)

After adjusting for covariates, compared with patients without disability, pre-stroke disability was not associated with a lower chance of obtaining a favorable outcome within 90 days (24% vs.
30%; OR, 0.

Pre-stroke disabled patients without diabetes , the Alberta Stroke Project's early CT score> 8 and the National Institutes of Health Stroke Scale score <17 showed safety and results similar to those without pre-stroke disability after MT
.

Despite the higher risk of mortality and symptomatic intracranial hemorrhage, pre-stroke disabled patients often return to their pre-stroke functional levels as independent patients, especially non-diabetic patients with good early signs of ischemia
.
These data support the potential benefit of MT for patients with mild or moderate disability after stroke with large anterior vascular occlusion