ABSTRACT NUMBER: ESOC2026A1829 THROMBECTOMY BENEFITS ARE UNCERTAIN IN PATIENTS WITH ISCHEMIC STROKE, PRE-MORBID DISABILITY AND LARGE VESSEL OCCLUSION - A METAANALYSIS

Abstract Background and aims Multiple randomized control trials have shown that thrombectomy for ischemic stroke resulting from large vessel occlusion (LVO) reduces disability and is cost effective. There remains uncertainty whether thrombectomy for patients with pre-stroke disability (modified Rankin Score/mRS3-4) is similarly effective, as prior meta-analysis (n=14) included cases of mRS2 among those classified as pre-stroke disability. This study aimed to meta-analyse the outcomes of thrombectomy for LVO in those with moderate disability (mRS3-4). Methods We searched Pubmed, Medline and Clinicaltrials.gov using search terms "stroke", "large vessel occlusion", "disability", "prestroke disability", or "pre-stroke disability" on 4/1/2026. From 384 studies, we included those with >90 patients or if there were extractable data on cases with mRS3-4. Analyses were conducted in R using the meta and metafor packages. Results Of 27 studies, two duplicates were excluded. In the remaining 25 studies, 5084/60199 patients with a pre-stroke disability (10.6%, 95% CI 7.8-13.7, I2=99.3%) received thrombectomy. Mean age was 81.0±2.8years. The majority were female 64.9% (95% CI 61.8-67.9%, I2=97.2%). Return to baseline occurred in 27.3% (95% CI 23.2-31.5%, I2=98.9%) and symptomatic intracerebral hemorrhage occurred in 6.5% (95% CI 5.5-7.7%, I2=94.8%). Mortality was 39.5% (95% CI 34.0-45.1%, I2=99.4%). Conclusions The proportion of patients with pre-stroke disability treated by thrombectomy in LVO registries remains low while a modest proportion of the patients returned to baseline following thrombectomy. Surprisingly a large proportion of patients in registries were female, reversing trends seen previously. The high heterogeneity (I2) suggests a large variation in results, and further work in the form of a trial is needed. Conflict of interest Jason Vuong: nothing to disclose, Shaloo Singhal: nothing to disclose, Michael Valente: nothing to disclose, Angelos Sharobeam: nothing to disclose, Lubna Shakhatreh: nothing to disclose, Andy Lim: nothing to disclose, Peter Mitchell: nothing to disclose, Bernard Yan: nothing to disclose, Henry Ma: nothing to disclose, Thanh Phan: nothing to disclose.