Endovascular Thrombectomy in Patients With Preexisting Disability: A Review

Abstract

Endovascular mechanical thrombectomy (EVT) drastically reduces disability after acute ischemic stroke due to large‐vessel occlusion, but only a small proportion of patients with stroke are eligible for this powerful treatment. Several ongoing studies are aiming to expand the indications for EVT to further reduce disability after acute ischemic stroke for a larger proportion of patients suffering from large‐vessel occlusion stroke. Patients with preexisting disability, comprising ≈30% of all patients with acute ischemic stroke, were universally excluded from the landmark clinical trials that established EVT efficacy. These patients disproportionally suffer from accumulated disability after stroke, with substantial societal and economic impact. Further, there is significant heterogeneity in current practice of EVT among patients with preexisting disability. Establishing evidence‐based acute stroke treatments for this population is a priority. In this narrative review, we summarize the current literature regarding EVT in patients with preexisting disability. While doing so, we highlight key concepts regarding statistical analysis and discuss opportunities and challenges for future studies focusing on this vulnerable population.