AIM: To assess the effectiveness and safety of endovascular treatment (EVT) versus medical management (MM) in stroke patients with premorbid disabilities.

MATERIAL and METHODS: A systematic search was conducted in PubMed, Embase, and the Cochrane Library for studies on EVT in large vessel occlusion (LVO) patients with pre-stroke modified Rankin Scale (mRS) score of 2-4. The primary outcome was functional recovery, defined as returning to at least the pre-stroke mRS score within 90 days. The secondary outcomes included symptomatic intracranial hemorrhage (sICH) and 90-day mortality. The meta-analyses were conducted via random effects models.

RESULTS: Six cohort studies involving 2,106 patients were included. Compared with MM, EVT was associated with a higher likelihood of functional recovery (adjusted odds ratio [aOR], 3.26; 95% confidence interval [CI], 2.26-4.70; p<0.001) and lower risk of mortality (aOR, 0.40; 95% CI, 0.20-0.83; p=0.01). EVT was also associated with a potentially increased risk of sICH, although the difference did not reach statistical significance (aOR 2.47, 95% CI 0.81-7.52; p=0.11).

CONCLUSION: Although EVT may be associated with a higher potential risk of sICH, it improves the likelihood of functional recovery and reduces mortality in LVO patients with pre-stroke disability. Therefore, denying EVT solely on the basis of premorbid disability may be unjustified. Further high-quality randomized controlled trials are warranted to validate these findings.