Editors' Note: Prestroke Disability and Outcome After Thrombectomy for Emergent Anterior Circulation Large Vessel Occlusion Stroke

Abstract

In “Prestroke Disability and Outcome After Thrombectomy for Emergent Anterior Circulation Large Vessel Occlusion Stroke,” de Havenon et al. reported that of 407 patients with anterior circulation strokes, premorbid disability (defined as a modified Rankin Scale (mRS) score ≥2) was associated with a higher likelihood that the 90-day mRS score would not be increased from the premorbid mRS score compared with patients without premorbid disability. However, those with premorbid disability had a higher risk of death. Feng et al. suggest that it would be helpful to evaluate the relationship between the etiology of prestroke disability and postthrombectomy outcome, but de Havenon notes that data are not included in the TRACK registry. Siegler et al. question the use of accumulated disability as the outcome measure in this study given that patients with prestroke disability are more likely to have zero functional decline than patients with no prestroke disability. They note that the results of this study could be interpreted to mean patients who do not have prestroke disability benefit less from thrombectomy, but that this conclusion would be inaccurate given that the absence of prestroke disability is associated with a lower risk of death. They suggest that the lack of new disability or an mRS score 0–2 might have been a better outcome. de Havenon responds that these end points would not be optimal either. They further comment that it would be ideal for a future study to compare outcomes among patients with premorbid disability via matched analysis of medical management vs thrombectomy. Additional research may facilitate a better understanding of factors associated with postthrombectomy outcome and impact selection criteria. Furthermore, this exchange demonstrates the fact that there are limitations of the scales that we use to assess disability following stroke. In “Prestroke Disability and Outcome After Thrombectomy for Emergent Anterior Circulation Large Vessel Occlusion Stroke,” de Havenon et al. reported that of 407 patients with anterior circulation strokes, premorbid disability (defined as a modified Rankin Scale (mRS) score ≥2) was associated with a higher likelihood that the 90-day mRS score would not be increased from the premorbid mRS score compared with patients without premorbid disability. However, those with premorbid disability had a higher risk of death. Feng et al. suggest that it would be helpful to evaluate the relationship between the etiology of prestroke disability and postthrombectomy outcome, but de Havenon notes that data are not included in the TRACK registry. Siegler et al. question the use of accumulated disability as the outcome measure in this study given that patients with prestroke disability are more likely to have zero functional decline than patients with no prestroke disability. They note that the results of this study could be interpreted to mean patients who do not have prestroke disability benefit less from thrombectomy, but that this conclusion would be inaccurate given that the absence of prestroke disability is associated with a lower risk of death. They suggest that the lack of new disability or an mRS score 0–2 might have been a better outcome. de Havenon responds that these end points would not be optimal either. They further comment that it would be ideal for a future study to compare outcomes among patients with premorbid disability via matched analysis of medical management vs thrombectomy. Additional research may facilitate a better understanding of factors associated with postthrombectomy outcome and impact selection criteria. Furthermore, this exchange demonstrates the fact that there are limitations of the scales that we use to assess disability following stroke.