Despite representing a substantial proportion of large vessel occlusion (LVO) patients, individuals with moderate-to-severe disabilities before their stroke are frequently excluded from endovascular thrombectomy treatments—but new research presented this week at the Society of NeuroInterventional Surgery (SNIS) annual meeting (20–24 July, Seattle, USA) suggests that carefully selected patients with pre-existing disabilities may still benefit from the procedure.
Researchers have found that successful restoration of blood flow was ultimately associated with less functional decline, greater odds of improvement from baseline and lower mortality among these patients.
In the study, researchers analysed data from 781 patients with pre-existing disabilities who underwent thrombectomy for LVO stroke between 2016 and 2025 through the international Stroke Thrombectomy and Aneurysm Registry (STAR). They compared patients who achieved successful reperfusion—restoration of blood flow to the affected area of the brain—versus those who did not.
Patients who achieved successful reperfusion were significantly less likely to experience worsening disability (62.2% vs 79.6%, respectively) and less likely to die within 90 days of their stroke (39.8% vs 57.7%, respectively) compared to those who failed to achieve successful reperfusion. Successful reperfusion was also associated with fewer procedural complications, while rates of symptomatic brain bleeding were similar between the two study 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 (Emory University School of Medicine, Atlanta, USA), senior author of the study and co-founder of STAR. “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 study also compared patients with pre-existing disability to those who had little or no disability before stroke. While patients with pre-stroke disability experienced poorer overall outcomes and higher mortality, researchers found that they still derived meaningful functional benefit from successful reperfusion.
“Every patient deserves the opportunity to be considered for the treatment most likely to help them recover from a stroke,” added Ali Tfaily (Emory University Laney Graduate School, Atlanta, USA), 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.”
