Clinical Scorecard: Factors Influencing Three-Month Functional Outcomes in Ischemic Stroke Patients with Discharge Disability After Endovascular Therapy: A Multi-Center Observational Study of 836 Individuals

At a Glance

Key Highlights

• Endovascular therapy combined with best medical management improves 90-day functional independence in AIS patients with LVO.
• A significant subset of patients remain functionally dependent at discharge, with unclear predictors of recovery by 3 months.
• This study identifies baseline, clinical, and procedural factors influencing functional independence at 3 months post-EVT in patients discharged dependent.

Guideline-Based Recommendations

Diagnosis

• Use NIHSS to assess baseline stroke severity.
• Perform non-contrast CT with ASPECTS scoring (≥6) to evaluate ischemic changes pre-EVT.
• Confirm large vessel occlusion via imaging to select EVT candidates.

Management

• Administer intravenous thrombolysis (Alteplase 0.9 mg/kg) prior to EVT when eligible within time window.
• Perform mechanical thrombectomy aiming for successful reperfusion (mTICI 2b–3).
• Discharge planning should consider functional status (mRS) and rehabilitation needs.

Monitoring & Follow-up

• Assess functional outcome at 3 months post-EVT using the modified Rankin Scale.
• Monitor for hemorrhagic complications such as parenchymal hematoma per ECASS criteria.
• Follow-up via clinical visits or standardized telephone interviews by trained personnel.

Risks

• Risk of persistent functional dependence despite EVT.
• Potential hemorrhagic complications including parenchymal hematoma.
• Delayed recovery influenced by neurological reserve, rehabilitation access, and social support.

Patient & Prescribing Data

Adults ≥18 years with AIS due to LVO, pre-stroke mRS 0–2, treated with EVT, discharged with mRS > 2

Bridging therapy with IV thrombolysis prior to EVT is standard when eligible; successful reperfusion correlates with better outcomes; functional recovery post-discharge is variable and influenced by multiple factors.

Clinical Best Practices

• Select EVT candidates based on clinical and imaging criteria including NIHSS and ASPECTS scores.
• Aim for successful reperfusion (mTICI 2b–3) during EVT to improve functional outcomes.
• Implement early and individualized rehabilitation strategies post-discharge for patients with functional dependence.
• Use standardized mRS assessments at discharge and 3 months to guide prognosis and care planning.
• Ensure multidisciplinary follow-up including neurologists and rehabilitation specialists to optimize recovery.

References

• Endovascular Therapy for Acute Ischemic Stroke
• Modified Rankin Scale for Stroke Outcome Assessment
• European Cooperative Acute Stroke Study (ECASS) Hemorrhagic Transformation Criteria