Survival, Recorded Disability, and Neurorehabilitation After Advanced Endovascular Stroke Care in Kazakhstan: A Retrospective Cohort Study

Background: Advanced endovascular procedures are increasingly used for ischemic stroke, but real-world evidence from middle-income settings remains limited, particularly regarding survival, disability, and neurorehabilitation. This study examined mortality, recorded disability, procedure-related differences, and neurorehabilitation exposure among patients receiving high-technology stroke care in Almaty, Kazakhstan. Methods: We conducted a retrospective cohort study of 328 adults with ischemic stroke who underwent endovascular or stent-based procedures between 2014 and 2024. Survival was assessed using Kaplan-Meier analysis and Cox proportional-hazards regression. Binary mortality status and recorded disability were examined using logistic regression. Procedure codes were grouped as mechanical thrombectomy/endovascular removal, intracranial stenting, and embolization/coiling/other procedures. Results: Neurorehabilitation was received by 39% of patients and was associated with better crude survival (1 year survival 93.6% vs. 76.7%; 5-year survival 69.0% vs. 60.7%; log-rank p = 0.001). In the adjusted Cox model, older age (HR = 1.069, 95% CI 1.046-1.092, p < 0.001) and greater total bed-day burden (HR = 1.071, 95% CI 1.029-1.116, p = 0.001) were associated with higher mortality hazard. Binary neurorehabilitation was not independently associated with survival (p = 0.803). Male sex was the only consistent factor associated with recorded disability (fully adjusted OR = 2.662, 95% CI 1.261-5.617, p = 0.010). Conclusions: Older age and bed-day burden were the most stable mortality-related factors. Neurorehabilitation was linked to better crude survival but not adjusted survival or recorded disability. Procedure-related and disability findings should be considered exploratory because baseline stroke severity and validated functional scales were unavailable.