Study suggests patients with pre-existing disabilities may benefit from thrombectomy

Patients with moderate‑to‑severe pre‑stroke disabilities are often disqualified for endovascular thrombectomy (EVT), the rapid clot‑removal procedure used to treat large‑vessel occlusion strokes. This exclusion occurs even though such patients constitute a sizable share of all large‑vessel stroke admissions. Current selection criteria, largely based on the National Institutes of Health Stroke Scale and functional status scores, tend to favor individuals with minimal or no prior disability, leaving a gap in care for those who already live with significant impairments.

The rationale behind these restrictions stems from concerns about procedural risk, limited potential for functional recovery, and the possibility of diminishing the overall benefit of EVT. However, recent observational studies have shown that many patients with pre‑existing disabilities still achieve meaningful neurological improvement after thrombectomy, and that their outcomes are comparable to those of less disabled peers when adjusted for age and comorbidities. Despite this evidence, guideline committees have yet to revise eligibility thresholds, and many stroke centers continue to apply the same strict criteria.

Re‑examining the criteria for EVT eligibility could broaden access to life‑saving treatment for a vulnerable population that is currently underserved. A more nuanced approach—considering individual functional goals and potential for recovery—might improve outcomes and reduce disparities in stroke care.