Evidence map›Paper›PMID 41084289›Full record

ReviewJournal of stroke2025

Decision-Making for Endovascular Thrombectomy in Patients With Large Vessel Occlusions and Mild Neurological Deficit: A Consensus Statement.

Salome L Bosshart, Manon Kappelhof, Alexander Stebner, Satoru Fujiwara, Petra Cimflova, Marie-Sophie Schüngel, Genevieve Milot, Pascal J Mosimann, Joanna D Schaafsma, Marc Ribo and 21 more

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Journal of stroke, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

31 authors.

Salome L BosshartDepartment of Clinical Neurosciences, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada.
Manon KappelhofDepartment of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
Alexander StebnerDepartment of Clinical Neurosciences, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada.
Satoru FujiwaraDepartment of Neurology, Kobe City Medical Center General Hospital, Kobe, Japan.
Petra CimflovaDepartment of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, Bern, Switzerland.
Marie-Sophie SchüngelPoliclinic of Radiology and Interventional Radiology, Department of Neuroradiology, University Hospital Halle, Halle (Saale), Germany.
Genevieve MilotCHU de Quebec-Universite Laval, Quebec City, QC, Canada.
Pascal J MosimannInterventional and Diagnostic Neuroradiology, University of Toronto & Toronto Western Hospital, Toronto, ON, Canada.
Joanna D SchaafsmaDivision of Neurology, Department of Medicine and Division of Neuroradiology, Department of Medical Imaging, University Health Network, Toronto, ON, Canada.
Marc RiboDepartment of Neurology, Hospital Vall d'Hebrón, Barcelona, Spain.
Alexandra R PaulDepartment of Neurosurgery, Albany Medical Center, Albany, NY, USA.
Christian UlfertNeuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany.
Mohammed AlmekhlafiDepartment of Clinical Neurosciences, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada.
Isabel FragataNeuroradiology Department, ULS S. José, Lisbon, Portugal.
Sandor NardaiSemmelweis University, Department of Neurosurgery and Neurointervention, Budapest, Hungary.
Demetrius K LopesDepartment of Neurosurgery, Advocate Aurora Health Inc, Park Ridge, IL, USA.
Bijoy MenonDepartment of Clinical Neurosciences, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada.
Pervinder BhogalInterventional Neuroradiology, Royal London Hospital, London, UK.
Umberto PensatoDepartment of Neurology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
Christine HawkesDivision of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
Shinichi YoshimuraDepartment of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan.
Violiza InoaDepartment of Neurology, University of Tennessee Health Science Center, Memphis.
Aravind GaneshDepartment of Clinical Neurosciences, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada.
Nishita SinghNeurology Division, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
David VoldersDepartment of Radiology, Dalhousie University, Halifax, NS, Canada.
Manuel MoreuNeurointerventional Unit, Radiology Department, Hospital Clínico Universitario San Carlos, Madrid, Spain.
Kazutaka UchidaDepartment of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan.
Shahid NimjeeDepartment of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Jeffrey L SaverDepartment of Neurology, University of California, Los Angeles, CA, USA.
Michael D HillDepartment of Clinical Neurosciences, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada.
Johanna M OspelDepartment of Clinical Neurosciences, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Acute ischemic stroke patients with mild deficits (National Institutes of Health Stroke Scale [NIHSS] of 0-5) but confirmed large vessel occlusions (LVO) present a clinical challenge for endovascular thrombectomy (EVT) decisions due to limited evidence and the absence of clear guidelines. A Delphi consensus was conducted at the 2024 5T (Teamwork, Training, Technology, Technique, Transport) Think Tank conference with 40 international stroke experts. Following a systematic literature review, three iterative Delphi rounds were employed to explore EVT decision-making in strokes due to LVO with low NIHSS. Data were collected through surveys and in-person discussions, focusing on disability evaluation, imaging markers, procedural risk, and outcome scales. Consensus was achieved on key factors influencing EVT decisions. Experts emphasized the importance of symptom-specific disability (e.g., aphasia, vision loss) over NIHSS scores alone. Early neurological deterioration (END) was perceived as main concern in this patient population. Imaging markers such as proximal occlusion, poor collaterals, and large penumbra were expected to be predictors of END. The anticipated technical difficulty and patient-specific factors, such as independence and quality of life, also guided decisions. The Potential of rtPA for Ischemic Strokes With Mild Symptoms (PRISMS) trial definition of disabling deficits and the 9-level modified Rankin Scale were favored as outcome measures for future studies. EVT decisions for acute ischemic strokes with mild deficit but proven LVO require nuanced, individualized approaches beyond NIHSS thresholds. Disability assessment, imaging-based risk evaluation, and patient-centered discussions are critical for optimizing outcomes, emphasizing the need for further research and standardized guidelines.

Indexed as

Early neurological deteriorationLarge-vessel occlusionLow NIHSSMild deficitStrokeThrombectomy

Identifiers

PMID41084289
PMCPMC12527580

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.