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Background <p>Endovascular therapy (EVT) is the standard of care for acute ischemic stroke due to large vessel occlusion. While predictors of 90-day functional outcome are well-established, the determinants of functional recovery remain less clearly defined in the post-discharge period for patients with initial disability. We aimed to identify the predictors of functional outcome at 3&#xa0;months in patients who underwent EVT and were discharged with an unmet need for recovery (modified Rankin scale (mRS) score &gt; 2).</p> Methods <p>A multi-center, observational cohort study was conducted using data from the Big Data Observatory Platform for Stroke in China. We included 836 patients from eight comprehensive stroke centers (August 2018 – December 2024) who received EVT, had a pre-stroke mRS of 0–2, and had an mRS &gt; 2 at discharge. The primary outcome was functional outcome at 3&#xa0;months post-EVT, defined as an mRS score of 0–2. Univariate and multivariate logistic regression analyses were performed to identify independent predictors.</p> Results <p>Of the 836 patients, 151 (18.1%) achieved a favorable functional outcome (mRS 0–2) at 3&#xa0;months. In univariate analysis, the favorable outcome group was significantly younger, had a lower pre-EVT NIHSS, a lower rate of atrial fibrillation, a higher rate of intravenous thrombolysis, a higher rate of complete recanalization (mTICI 3), and a lower rate of parenchymal hematoma (PH) (all <i>p</i> &lt; 0.05). Multivariate regression confirmed four independent predictors: younger age (aOR: 0.973; 95% CI: 0.958–0.989; <i>p</i> = 0.001), lower pre-EVT NIHSS (aOR: 0.940; 95% CI: 0.912–0.968; <i>p</i> &lt; 0.001), complete recanalization (aOR: 1.921; 95% CI: 1.305–2.826; <i>p</i> = 0.001), and absence of PH (aOR: 0.424; 95% CI: 0.235–0.768; <i>p</i> = 0.005).</p> Conclusion <p>A significant proportion of patients discharged with disability experiences meaningful functional recovery by 3&#xa0;months post-EVT. The key predictors of this subsequent recovery are younger age, milder initial stroke severity, complete reperfusion, and the avoidance of hemorrhagic complications.</p>

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Predictors of functional outcome at 3 months in ischemic stroke patients with discharge disability following endovascular therapy: a multi-center observational cohort study of 836 patients

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  • 发表日期：

    2026年1月6日

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  • Mohammad Mofatteh,
  • Xiao Xiao,
  • Yimin Chen,
  • Junyi Hu,
  • Mingzhu Feng,
  • Jicai Ma,
  • Lue Chen,
  • Sijie Zhou,
  • Xiuling Zhang,
  • Zunbao Xu,
  • Jiale Wu,
  • Yongting Zhou,
  • Yuzheng Lai,
  • Wenhong Peng

摘要

Background

Endovascular therapy (EVT) is the standard of care for acute ischemic stroke due to large vessel occlusion. While predictors of 90-day functional outcome are well-established, the determinants of functional recovery remain less clearly defined in the post-discharge period for patients with initial disability. We aimed to identify the predictors of functional outcome at 3 months in patients who underwent EVT and were discharged with an unmet need for recovery (modified Rankin scale (mRS) score > 2).

Methods

A multi-center, observational cohort study was conducted using data from the Big Data Observatory Platform for Stroke in China. We included 836 patients from eight comprehensive stroke centers (August 2018 – December 2024) who received EVT, had a pre-stroke mRS of 0–2, and had an mRS > 2 at discharge. The primary outcome was functional outcome at 3 months post-EVT, defined as an mRS score of 0–2. Univariate and multivariate logistic regression analyses were performed to identify independent predictors.

Results

Of the 836 patients, 151 (18.1%) achieved a favorable functional outcome (mRS 0–2) at 3 months. In univariate analysis, the favorable outcome group was significantly younger, had a lower pre-EVT NIHSS, a lower rate of atrial fibrillation, a higher rate of intravenous thrombolysis, a higher rate of complete recanalization (mTICI 3), and a lower rate of parenchymal hematoma (PH) (all p < 0.05). Multivariate regression confirmed four independent predictors: younger age (aOR: 0.973; 95% CI: 0.958–0.989; p = 0.001), lower pre-EVT NIHSS (aOR: 0.940; 95% CI: 0.912–0.968; p < 0.001), complete recanalization (aOR: 1.921; 95% CI: 1.305–2.826; p = 0.001), and absence of PH (aOR: 0.424; 95% CI: 0.235–0.768; p = 0.005).

Conclusion

A significant proportion of patients discharged with disability experiences meaningful functional recovery by 3 months post-EVT. The key predictors of this subsequent recovery are younger age, milder initial stroke severity, complete reperfusion, and the avoidance of hemorrhagic complications.