Abstract TP183: Endovascular Thrombectomy in Patients With Pre-Existing Disability Presenting With Large Vessel Occlusion Stroke

Abstract

Introduction: Despite representing a substantial proportion of patients who present with large vessel occlusion (LVO) acute ischemic stroke (AIS), patients with baseline disability are often excluded from endovascular thrombectomy (EVT) clinical trials. We present our institutional experience with EVT in this patient population. Methods: Prospectively maintained database from our comprehensive stroke center was retrospectively reviewed for consecutive cases from December 2014 to July 2023. Patients who underwent EVT were included. Two groups of patients were created; patients without existing disability (modified Rankin Score [mRS] 0-1) and those with existing disability (mRS≥2). Demographics and comorbidities were compared. Difference in 90 day mRS and baseline mRS (delta mRS) was calculated as primary outcome measure. Wilcoxon rank test and generalized linear regression were used for analysis. Results: Total of 1441 patients were identified, 347 patients (24.1%) had pre-existing disability.This group had higher average age (82 vs 68, p<0.01), a higher proportion of female patients (66.57% vs 41.13%, p<0.001), and elevated rates of comorbidities such as atrial fibrillation, diabetes, and hypertension. Additionally, they presented with a slightly higher median NIHSS of 18 (vs 15, p<0.001).There was no difference in the rate of successful reperfusion (TICI 2b-3:90.49% vs 87.53%, p=0.16), or symptomatic ICH (1.44% vs 1.83%, p=0.75) between the two groups. Higher rate of delta mRS=0 (return to baseline) was observed in patients with pre-existing disability (17.58% vs 8.98%, p<0.001). Similarly, delta mRS ≤ 1 was higher in this group (33.43% vs 22.36%, p<0.001). In multivariable analysis, after adjusting for initial stroke severity and ASPECTS, patients with pre-existing disabilities had higher rate of return to baseline functional status and similar rate of ICH. Pre-existing deficit predicted an increase in delta mRS ≤ 1 (β=1.04, p<0.001). Conclusion: EVT appears to be safe and effective in patients with baseline disability, often returning patients to their pre-morbid functional status by 90 days follow up. Although further studies are needed, it is reasonable to offer EVT for patients with baseline disability presenting with LVO stroke.