Predictors of Functional Outcome After Thrombectomy in Patients With Prestroke Disability in Clinical Practice
Authors: Millán Mònica , Ramos-Pachón Anna , Dorado Laura , Bustamante Alejandro , Hernández-Pérez María , Rodríguez-Esparragoza Luís , Gomis Meritxell , Remollo Sebastia , Castaño Carlos , Werner Mariano , Wenger Denisse , Rubio Sara , Domínguez-Lizarbe Manuel , Terceño Mikel , Paipa Andrés Julián , Rodríguez-Vázquez Alejandro , Boned Sandra , Camps-Renom Pol , Cánovas David , Giralt Eva , López-Cancio Elena , Dávalos Antoni , Ros-Roig Josep , Pérez de la Ossa Natalia , Cardona Pere , Quesada Helena , Lara Blanca , Nuñez Guillen Ana , Barranco Roger , Aja Lucia , Mora Paloma , Chirife Oscar , Aixut Sonia , Angeles de Miquel Maria , Martínez-Yelamos Toni , Molina Carlos , Rubiera Marta , Pagola Jorge , Rodríguez-Luna David , Muchada Marian , Tomasello Alejandro , Ribó Marc , Piñana Carlos , Requena Manuel , Deck Matías , Garcia-Tornel Alvaro , Olivé Marta , Rodriguez Noelia , Jueg Jesus , Chamorro Ángel , Amaro Sergio , Urra Xabier , Llull Laura , Renú Arturo , Rudiloso Salvatore , Macho Juan M. , Blasco Jordi , San Roman Manzanera Luis , López Antonio , Zarco Federico , Torné Ramón , Valero Ricard , Obach Víctor , Vera Víctor , Vargas Martha , Laredo Carlos , Martí-Fàbregas Joan , Delgado-Mederos Raquel , Martínez-Domeño Alejandro , Prats-Sánchez Luis , Guisado-Alonso Daniel , Guasch-Jiménez Marina , Marín Bueno Rebeca , Branera-Pujol Jordi , Pablo Martínez José , Dinia Lavinia , Pellisé Anna , Ustrell Xavier , Flores Alan , Seró Laia , Serena Joaquín , Silva Yolanda , Bashir Saima , Vera Víctor , Murillo Alan , Krupinski Jerzy , Huertas Sonia , Molina Jessica , Figueras Georgina , Besora Sarah , Rodríguez-Campello Ana , Roquer Jaume , Ois Ángel , cuadrado-Godia Elisa , Jiménez-Conde Jordi , Vivas Elio , Guimaraens Polo , del Carmen Garcia Maria , Estela Jordi , Perendreu Joan , Romero Nicolas , Eduardo Correa Roberto , Barrachina Oriol , Broggi Moisès , Gómez-Choco Manuel , García Sonia M. , Àngels Font Padrós Maria , José Mengual Chirife Juan , Mena Romo Luis , Palomeras Ernest , Casado Virginia , Guanyabens Nicolau , Álvarez Marta , Catena Esther , Luis Camacho Velasquez José , Purroy Francisco , Mauri Gerard , Garcia Cristina , García Alhama Jessica , Bragado Trigo Irene , Monedero Jordi , Perecaula Mònica , Guillermo Casanovas Luis , Colom Carla , Cocho Dolores , Rios González Adela , Baiges Juanjo , Zaragoza Josep , Martin Gisela , Escalante Sonia , Esteve Patricia , Payo Iago , Binela Lidia , Maria Aragonés Josep , Matos Núria , Maria Soler-Insa Josep , Mas Natalia , Diaz Glòria , Vergés Margarida , Costa Xavier , Molina Liseth , Almendros M. Cruz , Pérez Marc , Cabanelas Ana , Belchi Olga , Rybyeba Maria , Barceló Miquel , Carrión Dolors , Repullo Carmen , Sanjurjo Eduard , Salvat-Plana Mercè , Roig Josep , Hidalgo Verònica , Fagúndez Olga , Sala Victòria , Alonso Anabel , Querol Marisol , Gorchs Montse , Jiménez Xavier , Àngels Mora Maria 
Published: October 2021

Background and Purpose:
Mechanical thrombectomy (MT) in ischemic stroke patients with poor prestroke conditions remains controversial. We aimed to analyze the frequency of previously disabled patients treated with MT in clinical practice, the safety and clinical response to MT of patients with preexisting disability, and the disabled patient characteristics associated with a better response to MT.

Methods:
We studied all consecutive patients with anterior circulation occlusion treated with MT from January 2017 to December 2019 included in the Codi Ictus Catalunya registry—a government-mandated, prospective, hospital-based data set. Prestroke disability was defined as modified Rankin Scale score 2 or 3. Functional outcome at 90 days was centrally assessed by a blinded evaluator of the Catalan Stroke Program. Favorable outcome (to return at least to prestroke modified Rankin Scale at 90 days) and safety and secondary outcomes were compared with patients without previous disability. Logistic regression analysis was used to assess the association between prestroke disability and outcomes and to identify a disabled patient profile with favorable outcome after MT.

Results:
Of 2487 patients included in the study, 409 (17.1%) had prestroke disability (313 modified Rankin Scale score 2 and 96 modified Rankin Scale score 3). After adjustment for covariates, prestroke disability was not associated with a lower chance of achieving favorable outcome at 90 days (24% versus 30%; odds ratio, 0.79 [0.57–1.08]), whereas it was independently associated with a higher risk of symptomatic intracranial hemorrhage (5% versus 3%; odds ratio, 2.04 [1.11–3.72]) and long-term mortality (31% versus 18%; odds ratio, 1.74 [1.27–2.39]) compared with patients without disability. Prestroke disabled patients without diabetes, Alberta Stroke Program Early CT Score >8 and National Institutes of Health Stroke Scale score <17 showed similar safety and outcome results after MT as patients without prestroke disability.

Conclusions:
Despite a higher mortality and risk of symptomatic intracranial hemorrhage, prestroke-disabled patients return as often as independent patients to their prestroke level of function, especially those nondiabetic patients with favorable early ischemic signs profile. These data support a potential benefit of MT in patients with previous mild or moderate disability after large anterior vessel occlusion stroke.