{
  "abstract": "Background Moderate to severe pre-stroke disability (modified Rankin Scale (mRS) score 3–5) is an exclusion criterion for endovascular thrombectomy (EVT) in acute ischemic stroke (AIS), yet outcomes for this group remain underexplored.Methods Patients who underwent EVT, dichotomized to mRS ≤2 or mRS 3–5, between October 2015 and March 2020 were included from a national stroke registry. Favorable functional outcome was defined as mRS 0–2 for the mRS ≤2 cohort or no worsening of the mRS for the mRS 3-5 cohort at hospital discharge and at 6 months. Other outcomes included in-hospital mortality, symptomatic intracranial hemorrhage (sICH), early neurological deterioration (END), and successful recanalization (modified Thrombolysis in Cerebral Infarction (mTICI) 2b-3). The effect of successful recanalization on functional outcome and predictors of favorable functional outcome was assessed in the pre-stroke mRS 3-5 group.Results Among 4353 patients included in the study, 203 (4.6%) had moderate to severe pre-stroke disability. No significant differences were found in favorable functional outcome at discharge (30.5% in mRS 3-5 group vs 33.0% in mRS 0-2 group, adjusted OR 1.21, 95% CI 0.87–1.70, P=0.25) and at 6 months (P=0.97), sICH (P=0.39), END (P=0.72), or successful recanalization (P=0.15). In-hospital mortality was higher in the pre-stroke mRS 3-5 group (P<0.009). Successful recanalization was significantly associated with favorable functional outcomes compared with no recanalization (P=0.008). Admission National Institutes of Health Stroke Scale score, onset to arterial puncture time, EVT technique, and successful recanalization independently predicted functional outcome among patients with pre-stroke mRS 3-5.Conclusion Moderate to severe pre-stroke disability was comparable to pre-stroke mRS 0-2 with respect to favorable functional outcomes after EVT, and may not be a justified exclusion criterion for EVT in AIS. Randomized studies are necessary to optimize decision-making and evaluate the broader impact of EVT in this population.",
  "authors": [
    {
      "affiliations": [
        "Radiological Sciences, Mental Health & Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK"
      ],
      "name": "Abdul Salam"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK"
      ],
      "name": "Waleed Butt"
    },
    {
      "affiliations": [
        "Division of Diagnostic and Therapeutic Neuroradiology, Medical Imaging, Unity Health St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada",
        "Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Jose Danilo Bengzon Diestro"
    },
    {
      "affiliations": [
        "Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA",
        "Neurointerventional & Neuroanalytics Consortium (NAN-C), School of Medicine, Toronto Metropolitan University, Toronto, Ontario, Canada",
        "Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK"
      ],
      "name": "Adam A Dmytriw"
    },
    {
      "affiliations": [
        "Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK",
        "Department of Neuroradiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK",
        "Department of Diagnostic Radiology, Hong Kong University, Hong Kong, Hong Kong"
      ],
      "name": "Yan-Lin Li"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, King’s College Hospital NHS Foundation Trust, London, UK",
        "School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK"
      ],
      "name": "Thomas C Booth"
    },
    {
      "affiliations": [
        "Image Guided Therapy Research Facility, University of Dundee, Dundee, UK"
      ],
      "name": "Anna Podlasek"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, Nottingham, UK"
      ],
      "name": "Luqman Malik"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, Nottingham, UK"
      ],
      "name": "Sujit Nair"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, Nottingham, UK"
      ],
      "name": "Norman Mcconachie"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, Nottingham, UK"
      ],
      "name": "Robert Lenthall"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, The Royal London Hospital, Barts Health NHS Trust, London, UK"
      ],
      "name": "Pervinder Bhogal"
    },
    {
      "affiliations": [
        "Stroke Trials Unit, Mental Health & Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK",
        "Stroke, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK"
      ],
      "name": "Timothy J England"
    },
    {
      "affiliations": [
        "Radiological Sciences, Mental Health & Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK",
        "NIHR, NIHR Nottingham Biomedical Research Centre, Nottingham, UK"
      ],
      "name": "Robert A Dineen"
    },
    {
      "affiliations": [
        "Radiological Sciences, Mental Health & Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK",
        "Interventional Neuroradiology, Gold Coast University Hospital, Southport, Queensland, Australia"
      ],
      "name": "Permesh Singh Dhillon"
    }
  ],
  "title": "Outcomes of patients with pre-stroke disability after acute ischemic stroke and endovascular thrombectomy",
  "uid": "46ce832c-b4f3-5325-9331-96a9164c3d93"
}