The vast majority of the important evidence regarding the use of endovascular therapy for stroke has substantial limitations. The critical studies, with the largest magnitude of benefit, used strict imaging criteria to limit interventions to large-vessel occlusions with only small-volume ischemic cores surrounded by large regions of surviving tissue. Further generalizing these data to the remaining stroke population represents a significant challenge.
This small study tries to describe the benefit of endovascular treatment in a population with larger ischemic core volumes, specifically those greater than 50 mL – and it’s useless. They have 56 patients in their retrospective case-control comparison, and are missing long-term follow-up data for 9. Outcomes, yes, are better for the endovascular therapy group – a handful of patients had low or minimal disability, while none of the control patients achieved an mRS 0-2. Safety outcomes, of course, are a total wash in a small sample such as this. This would have made for a great conference abstract, but it is hardly compelling or significant data.
The main notable feature of this study is mostly how it reflects the real-world deployment of this therapy, regardless of the guidelines and current evidence. Many centers have expanded the use of endovascular intervention for patients beyond the scope of the original trials. These are very, very weak data – and, even though I don’t disagree in principle with imaging-guided revascularization, the further away from established evidence we drift, the lower value the intervention becomes.
“Endovascular Treatment for Patients With Acute Stroke Who Have a Large Ischemic Core and Large Mismatch Imaging Profile”
https://www.ncbi.nlm.nih.gov/pubmed/27820620