Predictors of 3-Month Functional Independence in Ischemic Stroke Patients Discharged Dependent After EVT

Overview

This multi-center observational study of 836 ischemic stroke patients discharged with functional dependence after endovascular therapy (EVT) identified key factors associated with achieving functional independence at 3 months. Successful reperfusion, younger age, lower baseline stroke severity, and absence of parenchymal hematoma were significant predictors of improved outcomes.

Background

Ischemic stroke is a leading cause of adult disability and mortality worldwide. Endovascular therapy (EVT), especially mechanical thrombectomy, has become the standard of care for acute ischemic stroke due to large vessel occlusion, improving rates of vascular recanalization and functional outcomes. While many patients achieve functional independence by 90 days post-stroke, a substantial subset remains dependent at discharge, and the factors influencing their recovery trajectory between discharge and 3 months are less well understood. Understanding these determinants is critical for optimizing rehabilitation and long-term care planning.

Data Highlights

Key Findings

• Patients discharged with functional dependence (mRS > 2) after EVT can still achieve functional independence (mRS 0–2) by 3 months.
• Younger age and lower baseline NIHSS scores were independently associated with better 3-month outcomes.
• Successful reperfusion (mTICI 2b-3) and especially complete reperfusion (mTICI 3) strongly predicted improved functional recovery.
• The occurrence of parenchymal hematoma post-EVT was linked to poorer functional outcomes at 3 months.
• Administration of intravenous thrombolysis prior to EVT (bridging therapy) was part of treatment but its impact on recovery was less definitive.

Clinical Implications

Clinicians should recognize that patients discharged with disability after EVT still have potential for significant recovery by 3 months, particularly if they are younger, have lower initial stroke severity, and achieve successful reperfusion without hemorrhagic complications. These factors can guide prognostication, individualized rehabilitation planning, and resource allocation to optimize long-term functional outcomes.

Conclusion

This study highlights important predictors of functional independence at 3 months in ischemic stroke patients discharged dependent after EVT, emphasizing the role of reperfusion quality and baseline clinical factors. These insights support more tailored post-discharge management strategies to improve recovery trajectories.

References

1. Big Data Observatory Platform for Stroke in China -- Multi-Center Observational Study 2018-2024
2. European Cooperative Acute Stroke Study (ECASS) -- Parenchymal Hematoma Definition