Abstract TP136: Thrombectomy Outcomes In Patients With Elevated Modified Rankin Scores

Abstract

Introduction: The modified Rankin Scale (mRS) is a disability outcome measure often utilized in mechanical thrombectomy (MT) trials. An mRS of 0-2 at 90 days post intervention has been deemed a good functional outcome. Some trials required a pre-stroke mRS 0-1, while others included patients in the 0-2 range. None of the major trials enrolled patients with baseline mRS greater than 2, and there have been limited data/review of outcomes in these patients with inconclusive results. We conducted an institutional retrospective review to evaluate the proportion of patients who underwent successful MT (TICI 2b or higher) and remained at their baseline mRS. This will enable us to more appropriately evaluate if patients with higher baseline mRS should be considered for intervention. Methods: We conducted a retrospective review of all patients who underwent successful MT at our institution through 2021. Utilizing descriptive statistics in SAS, we specifically evaluated the number of patients who remained at their baseline mRS post intervention at each level. Results: 412 patients were included (259 patients with mRS 0, 66 with mRS 1, 36 with mRS 2, 29 with mRS 3, 16 with mRS 4, and 6 with mRS 5). Of the 412, 60 patients remained at their pre-stroke mRS at 90-days post intervention (14.29 % at mRS 0, 15.15% at 1, 16.67% at 2, 17.24% at 5, 0% at 4, and 33.33% at 5). Conclusion: Our data suggests that patients with higher baseline mRS, specifically mRS 3, may benefit from intervention with MT to maintain their functional ability. The proportion of patients who remained at their pre-stroke mRS was higher in the subgroup with mRS 3 comparative to mRS of 0 or 1; however, there were fewer patients overall. Our institutional data also highlights that patients with baseline mRS 3 did similarly well in maintaining their premorbid functional ability as those with mRS 2 (36 vs 29 patients, 17% in each group). This ultimately suggests that patients with baseline mRS 3 should be considered for MT. There are too few patients with baseline mRS 4 and 5 in our study, and given there is already significant disability in these subgroups, it would be difficult to conclude currently that these patients should undergo intervention.