Visual Tools for Informed Decision-Making in Large-Core Thrombectomy for Acute Ischemic Stroke.

Area of Science:

• Neurology
• Interventional Cardiology
• Public Health

Background:

• Randomized trials confirm endovascular thrombectomy (EVT) benefits for large ischemic cores.
• Hyperacute stroke care remains challenging, with high disability and mortality rates.
• Effective risk-benefit communication is crucial, potentially aided by visual tools.

Purpose of the Study:

• To pool data from large-core thrombectomy trials to quantify EVT's net benefit.
• To develop visual decision aids for acute stroke care.

Main Methods:

• Pooled modified Rankin Scale score data from 6 large-core thrombectomy trials.
• Calculated functional independence, acceptable outcomes, and adverse events (hemorrhage, hemicraniectomy).
• Quantified benefit per hundred and harm per hundred to determine net benefit; developed visual aids.

Main Results:

• EVT increased functional independence (19.5% vs 7.5%) and acceptable outcomes (36.5% vs 20.0%).
• EVT reduced severe disability (12.2% vs 20.6%) and mortality (31.0% vs 37.2%).
• Excess harm from EVT was 3.9%, with 40/100 expected to benefit and 4/100 to experience harm.

Conclusions:

• EVT offers significant benefits for large-core acute ischemic stroke.
• Increased risks of hemorrhage and surgical rescue are associated with EVT.
• Visual decision aids derived from pooled data facilitate informed decision-making in acute stroke.