Abstract Details

Title Endovascular Treatment in Acute Ischemic Stroke Patients with Pre-stroke Disability: A Systematic Review and Meta-analysis

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P6 - Poster Session 6 (5:00 PM-6:00 PM)

Poster/Presentation
Number 4-002

Objective To compare the efficacy and safety of Endovascular Treatment (EVT) with Best Medical Treatment (BMT) in acute ischemic stroke patients with prestroke disability (mRS ≥2).

Background Ischemic stroke remains a leading cause of disability and mortality. Although intravenous thrombolysis (IVT) and EVT are central to acute stroke care, pivotal trials largely excluded patients with prestroke disability (modified Rankin Scale [mRS] ≥2), limiting generalizability. This group lacks clear management, as standard favorable outcomes (mRS 0-2) are often inapplicable.

Design/Methods

Systematic searches were conducted with no date restrictions in PubMed, Cochrane, Web of Science, Scopus, and Embase from inception to July 2025. We identified original research on EVT in patients with prestroke disability, in English and with ≥4 patients. Data extraction and ROBINS-I risk of bias assessment were independently performed by two reviewers. Statistical analyses in R Studio used a random-effects model to estimate ORs (95% CIs), assessing heterogeneity. Primary outcomes were mortality, return to prestroke mRS, and sICH.

Results A total of 1,400 patients were analyzed, including 897 (64%) who received EVT and 503 (36%) who received BMT. All patients had pre-stroke disability, with prestroke mRS 2–4. Pooled analysis showed significantly lower mortality for EVT vs. BMT (OR: 0.49, 95% CI: 0.29–0.82, p=0.007). EVT patients were also significantly more likely to return to pre-stroke mRS level (OR: 3.21, 95% CI: 2.02–5.09, p<0.001). sICH was more frequent with EVT (OR: 2.24, 95% CI: 0.84–5.94), but not statistically significant (p=0.11).

Conclusions EVT significantly reduces mortality and improves return to baseline functional status in acute ischemic stroke patients with pre-existing disability. While increased sICH was observed with EVT, it was not statistically significant overall but was driven by one study. Our findings support EVT as a beneficial treatment for this often-excluded patient population, guiding clinical decision-making and addressing a crucial evidence gap.

Authors/Disclosures
Mariana Letícia d. Maximiano, MD PRESENTER	Dr. Maximiano has nothing to disclose.
Nicole B. Oliveira	Ms. Oliveira has nothing to disclose.
Lucca T. Carretta, Medical student	Mr. Carretta has nothing to disclose.
Rudolfh B. Arend, Sr.	Dr. Arend has nothing to disclose.
Henrique P. Gnoatto	Mr. Gnoatto has nothing to disclose.
Rafael T. Fonseca, Medical Student	Mr. Fonseca has nothing to disclose.
Filipe V. Ribeiro, MD	Ms. Ribeiro has nothing to disclose.
Ocilio R. Goncalves, MS	Mr. Goncalves has nothing to disclose.
Beatriz Gerente, Medical Student	Miss Gerente has nothing to disclose.
Pedro Rodrigues Teixeira, Student	Mr. Rodrigues Teixeira has nothing to disclose.
Tassiane C. Morais, PhD	Prof. Morais has nothing to disclose.
FERNANDO R. OLIVEIRA, Sr., PhD	Dr. OLIVEIRA has nothing to disclose.
LEANDRO D. BARBOSA, MD, PhD	Prof. BARBOSA has nothing to disclose.
AHMET GÜNKAN, MD	Dr. GÜNKAN has nothing to disclose.

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