Functional recovery patterns from discharge to 12 months after endovascular treatment for aneurysmal subarachnoid hemorrhage: a multicenter cohort study

Background Functional status after aneurysmal subarachnoid hemorrhage (aSAH) may improve after discharge, but paired assessments at discharge and long-term follow-up have rarely been used to distinguish delayed recovery from persistent disability. We characterized discharge-to-12-month recovery patterns after endovascular treatment and identified factors associated with persistent disability among patients with poor functional status at discharge. Methods This multicenter retrospective cohort study consecutively enrolled patients with aSAH who underwent endovascular treatment between April 2021 and April 2024 and had available mRS data at discharge and 12-month follow-up. Demographic characteristics, medical history, aneurysm-related features, laboratory parameters, clinical severity, and perioperative data were collected. Based on mRS scores at discharge and 12 months, patients were classified as persistently favorable, delayed recovery, or persistently poor. Among patients with poor functional status at discharge, univariable and multivariable logistic regression analyses were performed to identify factors associated with persistent functional disability. Results Among 1,637 patients, 1,328 (81.1%) were persistently favorable. Of 309 patients with poor functional status at discharge, 116 (37.5%) recovered functional independence by 12 months and 193 (62.5%) remained disabled. In the fully adjusted model, monocyte count (OR = 1.02, 95% CI: 1.00–1.04), modified World Federation of Neurosurgical Societies (mWFNS) grade (OR = 1.67, 95% CI: 1.29–2.18), and external ventricular drainage (EVD; OR = 3.71, 95% CI: 1.47–10.49) were associated with higher odds of persistent disability, whereas the systemic inflammation response index was associated with lower odds (OR = 0.99, 95% CI: 0.98–1.00). Conclusion Substantial heterogeneity exists in post-discharge functional recovery after endovascular treatment for aSAH. Clinical severity, external ventricular drainage, and inflammation-related indicators were associated with persistent disability. Recovery patterns based on mRS trajectories may support post-discharge risk stratification and rehabilitation follow-up.