ReviewFrontiers in surgery2026
Clinical equipoise and ethical challenges in expanding endovascular stroke thrombectomy practice.
Review in Frontiers in surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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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.
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.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Introduction: Endovascular thrombectomy transformed acute ischemic stroke care while exposing ethical tensions in emergency research. As landmark trials rapidly shifted standards, investigators faced complex questions regarding equipoise, early stopping, and respecting autonomy when patients lack capacity and time is critical. Methods: We conducted a focused literature analysis from 2003 to 2024 spanning practice-changing thrombectomy trials and contemporary ethics literature. We synthesized three domains: (1) equipoise dynamics during evidence accumulation; (2) balancing non-maleficence against the social value of continuing trials; and (3) consent models for incapacitated patients in time-sensitive settings. Results: Initial uncertainty regarding endovascular efficacy justified early randomized controls. However, post-2015 data precipitated a rapid loss of equipoise, necessitating the early termination of trials to uphold the duty of care for control arm participants. While early stopping rules successfully minimized harm, they raised tensions regarding the precision of treatment effect estimates. Furthermore, the requirement for standard informed or surrogate consent was found to introduce selection bias against severe stroke patients lacking capacity. The literature supports shifting toward deferred or presumed consent models in these emergencies, arguing that rigid adherence to autonomy can paradoxically violate the principles of justice and beneficence by systematically excluding the most vulnerable patient populations from life-altering interventions. Conclusions: Ethical conduct of emergency stroke trials requires continuous reassessment of equipoise, pre-specified stopping rules that prioritize participant welfare, and consent pathways tailored to incapacity and time sensitivity. We explore principles integrating beneficence, non-maleficence, autonomy, and justice to maximize lives saved and prevent disability while preserving rights. These principles generalize to future trials as indications, technologies, and timelines evolve.
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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.