The influence of prestroke disability on outcome in patients with a low Alberta Stroke Program Early CT Score who underwent endovascular thrombectomy
Authors: Matsukawa Hidetoshi , Uchida Kazutaka , Elawady Sameh Samir , Cunningham Conor , Sowlat Mohammad-Mahdi , Maier Ilko , Jabbour Pascal , Kim Joon-Tae , Wolfe Stacey Quintero , Rai Ansaar , Starke Robert M. , Psychogios Marios-Nikos , Samaniego Edgar A. , Arthur Adam S. , Yoshimura Shinichi , Cuellar-Saenz Hugo , Grossberg Jonathan A. , Alawieh Ali , Romano Daniele G. , Tanweer Omar , Mascitelli Justin , Fragata Isabel , Polifka Adam , Osbun Joshua , Crosa Roberto , Matouk Charles , Park Min S. , Levitt Michael R. , Brinjikji Waleed , Moss Mark , Williamson Richard , Navia Pedro , Kan Peter , De Leacy Reade , Chowdhry Shakeel , Ezzeldin Mohamad , Spiotta Alejandro M. 
Published: February 2025

OBJECTIVE
The definitive influence of prestroke disability on outcomes in patients with a low Alberta Stroke Program Early CT Score (ASPECTS) treated with endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) due to large-vessel occlusion (LVO) remains unknown. This study aimed to investigate the impact of prestroke disability on outcomes in this specific population.

METHODS
Data from 32 international centers for AIS-LVO patients with a low ASPECTS who underwent EVT between January 2013 and December 2022 were analyzed retrospectively. Low ASPECTS and prestroke disability were defined as ASPECTS values of 2–5 and prestroke modified Rankin Scale (mRS) score ≥ 2. The primary outcome was a return to the prestroke mRS score at 90 days. Secondary outcomes were independent ambulation (mRS scores of 0–3) or a return to the prestroke mRS score at 90 days, good functional outcome (mRS scores of 0–2) or a return to the prestroke mRS score at 90 days, successful recanalization, and 90-day mortality. Safety outcomes were any intracranial hemorrhage or symptomatic intracranial hemorrhage. A symptomatic intracranial hemorrhage was defined as an intracranial hemorrhage with an associated worsening of ≥ 4 points in the National Institutes of Health Stroke Scale score. Outcomes were compared between patients with and without prestroke disability.

RESULTS
Of 293 patients, 50 (17.1%) had a prestroke disability. Of 50 patients, 20 (40.0%), 24 (48.0%), and 6 (12.0%) had prestroke mRS scores of 2, 3, and 4, respectively. The primary outcome showed no significant difference between the two groups. Compared with patients without prestroke disability, those with prestroke disability had a significantly smaller proportion of independent ambulation or return to prestroke mRS score (adjusted OR 0.13, 95% CI 0.03–0.53) and good functional outcome or return to prestroke mRS score (adjusted OR 0.21, 95% CI 0.05–0.91). Other secondary and safety outcomes showed no significant difference between the two groups.

CONCLUSIONS
The present study indicated that prestroke disability was not associated with a return to the prestroke mRS score at 90 days or intracranial hemorrhage. Physicians should not routinely exclude AIS-LVO patients with a low ASPECTS who have prestroke disability from EVT based on prestroke disability alone.