Would you consider endovascular thrombectomy for acute stroke patients with large vessel occlusion (non-large core) but with poor functional baseline with mRS 3-4?

The Modified Rankin Scale (mRS) is a widely used tool for assessing functional status, ranging from 0 (no symptoms) to 6 (death). It provides a standardized framework for EVT decision-making based on a patient’s functional status and serves as a key criterion in EVT-related RCTs. While invaluable in both research and practice, the mRS has limitations, including a degree of subjectivity and a lack of nuance in evaluating overall functional capacity. Focusing primarily on physical limitations, it ...

Consider if this is the correct way to frame the question. The mRS is an outcome scale designed to focus on global functional neurological disability. It is not necessarily a good way to think about baseline status.

It is clear now that EVT is very powerful and there is a measurable effect size in a wide variety of patients, not just an early window, favorable scan, or among those with no pre-existing medical conditions.

The issue we all grapple with is when the prognosis is so poor because of t...

I offer thrombectomy for mRS of 3. I do consider what is causing the patient to fall in the category of mRS 4 (some may be at the lower spectrum of the score and some higher). Depending on what activities make the patient an mRS of 4 (someone may be in a wheelchair (because of an old injury) chronically but otherwise able to do most ADLs and IADLs versus someone in a wheelchair with continued functional decline needing help with most ADLs) and the NIHSS and location of the occlusion, I do offer ...