Predictors of functional outcome at 3 months in ischemic stroke patients with discharge disability following endovascular therapy: a multi-center observational cohort study of 836 patients

TL;DR

This study identifies factors that predict functional recovery in stroke patients three months after endovascular therapy, even if they were discharged with disability.

Contribution

The study identifies novel predictors of functional recovery in stroke patients post-discharge following endovascular therapy.

Findings

18.1% of patients with initial disability achieved a favorable functional outcome at 3 months.

Younger age, lower NIHSS, complete recanalization, and absence of PH were independent predictors of recovery.

Functional recovery is possible for a significant proportion of patients post-EVT.

Abstract

Endovascular therapy (EVT) is the standard of care for acute ischemic stroke due to large vessel occlusion. While predictors of 90-day functional outcome are well-established, the determinants of functional recovery remain less clearly defined in the post-discharge period for patients with initial disability. We aimed to identify the predictors of functional outcome at 3 months in patients who underwent EVT and were discharged with an unmet need for recovery (modified Rankin scale (mRS) score > 2).

A multi-center, observational cohort study was conducted using data from the Big Data Observatory Platform for Stroke in China. We included 836 patients from eight comprehensive stroke centers (August 2018 – December 2024) who received EVT, had a pre-stroke mRS of 0–2, and had an mRS > 2 at discharge. The primary outcome was functional outcome at 3 months post-EVT, defined as an mRS score of 0–2. Univariate and multivariate logistic regression analyses were performed to identify independent predictors.

Of the 836 patients, 151 (18.1%) achieved a favorable functional outcome (mRS 0–2) at 3 months. In univariate analysis, the favorable outcome group was significantly younger, had a lower pre-EVT NIHSS, a lower rate of atrial fibrillation, a higher rate of intravenous thrombolysis, a higher rate of complete recanalization (mTICI 3), and a lower rate of parenchymal hematoma (PH) (all p < 0.05). Multivariate regression confirmed four independent predictors: younger age (aOR: 0.973; 95% CI: 0.958–0.989; p = 0.001), lower pre-EVT NIHSS (aOR: 0.940; 95% CI: 0.912–0.968; p < 0.001), complete recanalization (aOR: 1.921; 95% CI: 1.305–2.826; p = 0.001), and absence of PH (aOR: 0.424; 95% CI: 0.235–0.768; p = 0.005).

A significant proportion of patients discharged with disability experiences meaningful functional recovery by 3 months post-EVT. The key predictors of this subsequent recovery are younger age, milder initial stroke severity, complete reperfusion, and the avoidance of hemorrhagic complications.

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