Depressive symptoms after endovascular thrombectomy are independent of functional outcome

INTRODUCTION: Post-stroke depression is a frequent yet underrecognized complication after ischemic stroke. In patients treated with endovascular thrombectomy (EVT), favorable functional recovery may mask psychological distress. METHODS: We conducted a prospective multicenter observational study including consecutive patients with anterior circulation large-vessel occlusion treated with EVT between February 2021 and June 2024. At 3 months, depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D; ≥16 indicating clinically significant symptoms), and additional patient-reported outcomes including anxiety, post-traumatic stress symptoms, fatigue, and subjective cognitive complaints were collected. Baseline clinical and imaging characteristics were recorded. Multivariable logistic regression analyses were performed to identify factors independently associated with depressive symptoms and their relationship with functional outcome. RESULTS: Among 559 patients treated with EVT (mean age 71 years; 49% women), 325 (58.1%) reported clinically significant depressive symptoms at 3 months. Depressive symptoms were observed across the spectrum of functional outcomes and were not independently associated with excellent functional outcome (modified Rankin Scale (mRS) 0-1) or functional independence (mRS 0-2). In contrast, depressive symptoms were strongly associated with anxiety (OR 8.19, 95% CI 2.79 to 24.07), post-traumatic stress symptoms (OR 7.31, 95% CI 1.71 to 33.30), fatigue (OR 2.85, 95% CI 1.70 to 4.77), and cognitive complaints (OR 2.06, 95% CI 1.21 to 3.50). A history of atrial fibrillation was independently associated with depressive symptoms (OR 1.72, 95% CI 1.02 to 2.83). CONCLUSIONS: Depressive symptoms are prevalent after EVT and represent a substantial component of post-stroke morbidity not captured by functional outcome scales, supporting integration of psychological assessment into post-EVT follow-up.