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@ARTICLE{Asperger:285631,
      author       = {Asperger, Hannah and Bode, Felix and Ebrahimi, Taraneh and
                      Kindler, Christine and Layer, Julia and Meißner, Julius
                      Nicolai and Nitsch, Louisa and Shirvani, Omid and
                      Thielscher, Christian and von Danwitz, Niklas Michael and
                      Weller, Johannes and Dorn, Franziska and Petzold, Gabor C
                      and Stösser, Sebastian},
      collaboration = {Investigators, GSR-ET},
      title        = {{I}mpact of {S}evere {P}restroke {D}isability on {O}utcomes
                      {A}fter {M}echanical {T}hrombectomy: {A} {M}ulticenter
                      {A}nalysis.},
      journal      = {Stroke: vascular and interventional neurology},
      volume       = {6},
      number       = {1},
      issn         = {2694-5746},
      address      = {Dallas, Tex.},
      publisher    = {American Heart Association, National Center},
      reportid     = {DZNE-2026-00270},
      pages        = {e002055},
      year         = {2026},
      abstract     = {Patients with severe prestroke disability (PSD) remain
                      underrepresented in mechanical thrombectomy studies, despite
                      their growing relevance in aging populations. This study
                      used data from the German Stroke Registry-Endovascular
                      Treatment to evaluate functional recovery, mortality, and
                      poststroke care outcomes in this high-risk population.We
                      analyzed 9456 mechanical thrombectomy-treated patients with
                      stroke from the German Stroke Registry-Endovascular
                      Treatment (2015-2021), categorized by premorbid modified
                      Rankin Scale (mRS): no PSD (mRS score, 0-1), moderate PSD
                      (mPSD; mRS score, 2-3), and severe PSD (sPSD; mRS score,
                      4-5). Favorable outcomes were defined as an mRS score of 0
                      to 2 or return to baseline. Logistic regression adjusted for
                      age, National Institutes of Health Stroke Scale, intravenous
                      thrombolysis, reperfusion success, and sex was used to
                      predict outcomes. A neural network subsequently explored
                      feature importance.Among 9456 patients, 7387 had no PSD,
                      1648 mPSD, and 421 sPSD. Unadjusted 90-day outcomes showed
                      increasing mortality with PSD severity and fewer favorable
                      outcomes in both PSD groups. At 90 days, favorable outcomes
                      occurred in 3020 patients without PSD $(40.9\%),$ 232 with
                      mPSD $(14.1\%),$ and 85 with sPSD $(20.2\%).$ After
                      adjustment, only mPSD was associated with lower odds of
                      favorable outcomes, while both mPSD and sPSD remained
                      independent predictors of higher mortality. Complication
                      rates were similar across groups, except for higher
                      vasospasm in patients without PSD. Including rebalanced sPSD
                      samples in predictive models resulted in minor performance
                      improvements but notable shifts in feature importance, with
                      age and Alberta Stroke Program Early Computed Tomography
                      Score emerging as key predictors, National Institutes of
                      Health Stroke Scale decreasing in relevance, and factors
                      such as local anesthesia and occlusion location becoming
                      more prominent.Despite higher mortality, approximately a
                      fifth of patients with PSD achieved favorable outcomes,
                      suggesting that this group should not be routinely excluded
                      from mechanical thrombectomy. Further studies should refine
                      patient selection criteria and outcome definitions for this
                      vulnerable population.URL: https://www.clinicaltrials.gov;
                      Unique identifier: NCT03356392.},
      keywords     = {dementia (Other) / patient discharge (Other) / sample size
                      (Other) / stroke (Other) / thrombectomy (Other)},
      cin          = {AG Spottke / AG Petzold / Patient Studies (Bonn) / AG
                      Schultze},
      ddc          = {610},
      cid          = {I:(DE-2719)1011103 / I:(DE-2719)1013020 /
                      I:(DE-2719)1011101 / I:(DE-2719)1013038},
      pnm          = {353 - Clinical and Health Care Research (POF4-353) / 354 -
                      Disease Prevention and Healthy Aging (POF4-354)},
      pid          = {G:(DE-HGF)POF4-353 / G:(DE-HGF)POF4-354},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:41816510},
      pmc          = {pmc:PMC12959425},
      doi          = {10.1161/SVIN.125.002055},
      url          = {https://pub.dzne.de/record/285631},
}