Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Apr;56(4):850-857.
doi: 10.1161/STROKEAHA.124.048997. Epub 2025 Mar 7.

Mechanical Thrombectomy in Prestroke Disability: Data From the Italian Endovascular Stroke Registry

Andrea Naldi  1 , Federico D'Agata  2 , Giovanni Pracucci  3 , Valentina Saia  4 , Roberto Cavallo  1 , Davide Castellano  5 , Fabrizio Sallustio  6 , Ilaria Casetta  7 , Enrico Fainardi  8 , Valerio Da Ros  9 , Ilaria Maestrini  10 , Sergio Lucio Vinci  11 , Paolino La Spina  12 , Nicola Limbucci  13 , Patrizia Nencini  14 , Elvis Lafe  15 , Marco Longoni  16 , Sandra Bracco  17 , Rossana Tassi  18 , Stefano Vallone  19 , Guido Bigliardi  20 , Paolo Cerrato  21 , Lucio Castellan  22 , Massimo Del Sette  23 , Roberto Menozzi  24 , Alessandro Pezzini  25   26 , Stefano Merolla  27 , Stefano Forlivesi  28 , Sergio Nappini  29 , Nicola Davide Loizzo  30 , Andrea Saletti  31 , Cristiano Azzini  32 , Guido Andrea Lazzarotti  33 , Nicola Giannini  34 , Daniele Giuseppe Romano  35 , Rosa Napoletano  36 , Nicola Burdi  37 , Giovanni Boero  38 , Alessio Comai  39 , Elisa Dall'Ora  40 , Nicola Cavasin  41 , Adriana Critelli  42 , Mauro Plebani  43 , Manuel Cappellari  44 , Domenico Sergio Zimatore  45 , Marco Petruzzellis  46 , Francesco Biraschi  47 , Ettore Nicolini  48 , Antioco Sanna  49 , Tiziana Tassinari  4 , Edoardo Puglielli  50 , Alfonsina Casalena  50 , Ivan Gallesio  51 , Delfina Ferrandi  52 , Pietro Filauri  53 , Simona Sacco  54 , Adriana Paladini  55 , Annalisa Rizzo  56 , Michele Besana  57 , Alessia Giossi  58 , Marco Pavia  59 , Paolo Invernizzi  60 , Pietro Amistà  61 , Monia Russo  62 , Marco Filizzolo  63 , Marina Mannino  64 , Gianluca Galvano  65 , Eleonora Lidia Saracco  66 , Mauro Bergui #  67 , Salvatore Mangiafico #  68 , Danilo Toni #  69 ; IRETAS Collaborators
Affiliations

Mechanical Thrombectomy in Prestroke Disability: Data From the Italian Endovascular Stroke Registry

Andrea Naldi et al. Stroke. 2025 Apr.

Abstract

Background: The benefits and safety of mechanical thrombectomy (MT) in patients with prestroke disability, classified as modified Rankin Scale (mRS) score of 3 to 4, and anterior circulation stroke remain uncertain. This study aims to evaluate these factors using data from the Italian Registry of Endovascular Treatment in Acute Stroke.

Methods: We analyzed data collected between 2015 and 2021, comparing functional outcomes (mRS), symptomatic intracerebral hemorrhage, and recanalization rates (Thrombolysis in Cerebral Infarction) at 90 days post-MT in patients with prestroke mRS score of 3 to 4 versus 0 to 2. A good outcome was defined as no change in the mRS score from baseline. Subgroup analysis was stratified by age.

Results: A total of 11.411 (96%) patients with prestroke mRS score of 0 to 2 and 477 (4%) patients with prestroke mRS score of 3 to 4 were included. Compared with patients with a baseline mRS score 0 to 2, those with mRS score 3 to 4 were older (82 versus 75 years; P<0.001) and predominantly female (71.7% versus 53%; P<0.001). The maintenance of the same mRS score after MT was observed in 100 (23.3%) patients with prestroke mRS score 3 to 4, compared with 2332 (22.1%) patients with mRS score 0 to 2 (P=0.556). Mortality was significantly higher in the mRS score 3 to 4 group (n=159 [37.1%] versus n=1939 [18.4%]; P<0.001). Successful recanalization (Thrombolysis in Cerebral Infarction score ≥2b) was lower in the mRS score 3 to 4 group (n=333 [71.6%] versus n=8706 [77.7%]; P=0.002), while no significant differences in symptomatic intracerebral hemorrhage were found. The benefit of MT was maintained in patients aged 80 to 85 and over 85 years with prestroke mRS score 3 to 4, although mortality remained higher.

Conclusions: Our data suggest that prestroke disability does not imply less chance of returning to prestroke conditions after MT, even in octogenarians, despite higher mortality and lower recanalization rate. More data are warranted to better understand the benefit of MT in this subgroup of patients.

Keywords: cerebral infarction; intracranial hemorrhages; stroke; thrombectomy; thrombolytic therapy.

PubMed Disclaimer

Conflict of interest statement

Dr Nappini: consultancy for Medtronic, Cerenovus, Stryker, and Balt. Dr Cappellari: consultancy or advisory board fees or speaker honoraria from Pfizer/Bristol Myer Squibb and Daiichi Sankyo. Dr Romano: consultant at Balt Italy, Balt Europe, Penumbra, Microvention, Stryker Neuro, Wallaby-Phenox. Dr Sacco: compensation from Pfizer Canada, Inc, Lundbeck, Eli Lilly and Company, Allergan, Boehringer Ingelheim, AstraZeneca, Novo Nordisk, Abbott Canada, Teva Pharmaceutical Industries, and Novartis for consultant services; compensation from Novartis for other services; employment by Università degli Studi dell’Aquila; intellectual: president-elect of the European Stroke Organisation, second vice president of the European Headache Federation, specialty chief editor in Headache and Neurogenic Pain for Frontiers in Neurology, associate editor for The Journal of Headache and Pain, and assistant editor for Stroke. Dr Cavasin: compensation from MicroVention, Inc, and from Stryker for consultant services. Dr Limbucci: compensation from Balt, Johnson & Johnson Health Care Systems, Inc, Medtronic, Inc, Stryker Corporation, MicroVention, Inc, and Penumbra, Inc, for consultant services. The other authors report no conflicts.

Figures

Figure 1.
Figure 1.
Patient selection flowchart. mRS indicates modified Rankin Scale.
Figure 2.
Figure 2.
Changes in modified Rankin Scale (mRS) score and mortality relative to baseline disability (prestroke mRS on the vertical axis, poststroke mRS on the horizontal axis). Green: no mRS changes compared with baseline disability. Yellow: 1-point worsening shift in mRS. Orange: 2-point worsening shift in mRS. Red: ≥3-point worsening shift in mRS. Dark red: 3-month mortality.
Figure 3.
Figure 3.
Relationship between age and the risk of death (blue line), and age and the probability of maintaining the same prestroke modified Rankin Scale (mRS) score after stroke treated with mechanical thrombectomy (orange line), independently of baseline mRS.
See this image and copyright information in PMC

References

    1. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, et al. . Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2019;50:e344–e418. doi: 10.1161/STR.0000000000000211 - PubMed
    1. Turc G, Bhogal P, Fischer U, Khatri P, Lobotesis K, Mazighi M, Schellinger PD, Toni D, de Vries J, White P, et al. . European Stroke Organisation (ESO) - European Society for Minimally Invasive Neurological Therapy (ESMINT) guidelines on mechanical thrombectomy in acute ischemic Stroke. J Neurointerv Surg. 2023;15:e8. doi: 10.1136/neurintsurg-2018-014569 - PubMed
    1. Gil-Salcedo A, Dugravot A, Fayosse A, Landré B, Jacob L, Bloomberg M, Sabia S, Schnitzler A. Pre-stroke disability and long-term functional limitations in stroke survivors: findings from more of 12 years of follow-up across three international surveys of aging. Front Neurol. 2022;13:888119. doi: 10.3389/fneur.2022.888119 - PMC - PubMed
    1. Ganesh A, Luengo-Fernandez R, Pendlebury ST, Rothwell PM. Long-term consequences of worsened poststroke status in patients with premorbid disability. Stroke. 2018;49:2430–2436. doi: 10.1161/STROKEAHA.118.022416 - PMC - PubMed
    1. Goldhoorn RB, Verhagen M, Dippel DWJ, van der Lugt A, Lingsma HF, Roos YBWEM, Majoie CBLM, Vos JA, Boiten J, van Zwam WH, et al. ; MR CLEAN Registry Investigators. Safety and outcome of endovascular treatment in prestroke-dependent patients. Stroke. 2018;49:2406–2414. doi: 10.1161/STROKEAHA.118.022352 - PubMed