Patients with moderate-to-severe disabilities before a stroke are frequently excluded from endovascular thrombectomy (EVT), despite representing a substantial proportion of patients with large vessel occlusion stroke. New research presented today at the Society of NeuroInterventional Surgery's 23rd Annual Meeting suggests that carefully selected patients with pre-existing disabilities may still benefit from the procedure. Researchers found that successful restoration of blood flow was associated with less functional decline, greater odds of improvement from baseline and lower mortality among these patients.

In the study, "Impact of Successful Reperfusion on Functional Outcomes After Thrombectomy in Patients with Pre-stroke Disability," researchers analyzed data from 781 patients with pre-existing disabilities who underwent EVT for large vessel occlusion stroke between 2016 and 2025 through the international Stroke Thrombectomy and Aneurysm Registry (STAR).

The researchers compared patients who achieved successful reperfusion - restoration of blood flow to the affected area of the brain - with those who did not. Patients with successful reperfusion were significantly less likely to experience worsening disability (62.2% vs. 79.6%) and less likely to die within 90 days of their stroke (39.8% vs. 57.7%). Successful reperfusion was also associated with fewer procedural complications, while rates of symptomatic brain bleeding were similar between the groups.

"Patients with a disability before their stroke have been considered ineligible for thrombectomy on the assumption they have too little to gain," said Ali Alawieh, MD, PhD, senior author of the study and co-founder of the STAR. "When we measured recovery against each patient's own baseline, they held onto their function comparable to patients who were independent before their stroke. Pre-existing disability alone shouldn't close the door on treatment."

The study also compared patients with pre-existing disability to those who had little or no disability before stroke. While patients with pre-stroke disability experienced poorer overall outcomes and higher mortality, researchers found that they still derived meaningful functional benefit from successful reperfusion.

"Every patient deserves the opportunity to be considered for the treatment most likely to help them recover from a stroke," said Ali Tfaily, MS, Doctoral Fellow at Emory University Laney Graduate School and primary author of the study. "Our findings suggest that carefully selected patients with pre-stroke disability can benefit from thrombectomy and that successful restoration of blood flow may help preserve independence, improve outcomes and reduce the risk of death after stroke."