Background: Practice-changing trials of
endovascular thrombectomy (EVT) for acute stroke excluded patients with
pre-morbid disability. Observational studies may inform the role of EVT in
this population. We performed a meta-analysis to estimate the effect of EVT
in patients with pre-morbid disability. Methods: We
adhered to PRISMA guidelines and searched Medline and Embase for studies
describing EVT in adults with and without pre-morbid disability with stroke.
Random-effects meta-analysis was used to pool outcomes, including favorable
outcomes (mRS=0-2 or return to baseline), no increase in disability at 90
days, symptomatic ICH (sICH) and 90-day mortality.
Results: We included 8 studies with 5570 patients
(mRS 3-5=863, mRS 0-2=4,707). Patients with pre-morbid disability were more
likely to return to their baseline mRS (aOR 2.53, 95% CI=1.47-4.36),
although they had higher 90-day mortality (aOR=2.21, 95% CI=1.66-2.93). aOR
for favorable outcome (aOR=0.83, 95% CI=0.67-1.03) or sICH (aOR=1.07, 95%
CI=0.74-1.54) was not significantly different between groups.
Conclusions: Observational studies suggest that
EVT is safe in patients with pre-stroke disability and may result in
comparable return to pre-stroke status as in patients without such
disability. These findings argue against the routine exclusion of patients
with pre-morbid disability from EVT and merit validation with randomized
controlled trials.