What question did this study set out to answer?

This research aims to examine how varying levels of comorbidity impact outcomes after endovascular thrombectomy in stroke patients.

January 22, 2026Open Access

The impact of comorbidity burden on outcomes following endovascular thrombectomy for acute ischemic stroke: A nationwide prospective observational study

Key Points

This research aims to examine how varying levels of comorbidity impact outcomes after endovascular thrombectomy in stroke patients.
Conducted a register-based observational study in Sweden from 2015 to 2021.
Included pre-stroke functionally independent patients undergoing endovascular thrombectomy.
Categorized comorbidity burden using the Charlson Comorbidity Index (CCI) into four groups: no, moderate, severe, and very severe comorbidity.
40% of patients had no comorbidity, while 24% had very severe comorbidity.
Higher comorbidity levels were linked to decreased odds of a favorable outcome, particularly in patients with severe and very severe comorbidity.
No significant differences in successful recanalization rates were observed, though it was associated with favorable outcomes across all comorbidity groups.

Abstract

Abstract Introduction Patients with substantial comorbidity burden are underrepresented in clinical trials on endovascular thrombectomy (EVT), despite being common in clinical routine care. Therefore, analysis of observational data is needed to evaluate how increasing comorbidity burden affects procedural success rate, complication rate, and clinical outcome following EVT. Patients and methods We conducted a register-based observational study involving pre-stroke functionally independent patients treated with EVT in Sweden 2015–2021. Comorbidity burden was assessed using the Charlson Comorbidity Index (CCI) and categorized as no (CCI 0), moderate (CCI 1), severe (CCI 2), and very severe (CCI ⩾3). The primary outcome was favorable 90-day outcome (modified Rankin Scale 0–2). Secondary outcomes included successful recanalization, and peri- and postoperative complications. Results Of 4735 included patients, 40% had no comorbidity (CCI 0), 15% had moderate (CCI 1), 21% had severe (CCI 2), and 24% had very severe comorbidity burden (CCI ⩾3). The yearly proportion of patients with very severe comorbidity burden increased from 16% to 30% during the study period. Increasing comorbidity levels were associated with decreased odds ratio (OR) of favorable outcome compared to patients without comorbidity: CCI 1 adjusted OR (aOR) 0.64, 95% CI 0.57–0.85; CCI 2 aOR 0.59, 95% CI 0.47–0.74; and CCI ⩾3 aOR 0.38, 95% CI 0.30–0.47, but there were no significant differences in successful recanalization rates. Patients with CCI 2 had higher OR for perioperative and postoperative complications (OR 1.43, 95% CI 1.09–1.88, and OR 1.41, 95% CI 1.15–1.71), and patients in the CCI ⩾3 group had higher OR of postoperative complications (OR 1.34, 95% CI 1.14–1.67), compared to patients in the CCI 0 group. Successful recanalization was associated with favorable functional outcome in all CCI-groups. Discussion and conclusion Severe and very severe comorbidity burden are increasingly common among EVT-treated patients in routine healthcare and are linked to poorer outcomes. However, our results suggest that successful EVT is associated with functional independency, also in patients with severe and very severe comorbidity burden.

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Cite This Study

Hall et al. (Thu,) studied this question.

synapsesocial.com/papers/6971be8d642b1836717e33ae https://doi.org/https://doi.org/10.1093/esj/23969873251332136

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