Choosing Meaningful Endpoints in Thrombectomy Trials: A Practical Review of Outcome Scales After Endovascular Thrombectomy
Year: 2026
Type: article
Abstract: Background: Endovascular thrombectomy (EVT) has expanded treatment for acute ischemic stroke. Outcome scales capturing disability, neurological deficit, imaging, safety, and patient-centered recovery are critical for interpreting trials. Objectives: To summarize clinical, patient-reported, imaging, and safety scales relevant to EVT trials and provide a practical framework for trialists selecting primary, secondary, exploratory, and safety endpoints. Methods: We conducted a narrative synthesis of landmark EVT trials, contemporary guidelines, common stroke outcome measures, and clinimetric studies. Scales were included if they had been used in EVT trials, were widely used in acute stroke research, or were clinically relevant to EVT populations. Results: The modified Rankin Scale (mRS), particularly the blinded 90-day ordinal mRS, remains the standard primary endpoint for most definitive EVT trials. Its limitations include interrater variability, ceiling and floor effects, and limited sensitivity to cognition, fatigue, aphasia, depression, return to work, and other patient-valued outcomes. Common secondary clinical outcomes include dichotomized mRS cut points, utility-weighted mRS, return-to-baseline mRS, National Institutes of Health Stroke Scale, Barthel Index, Functional Independence Measure, mortality, and discharge destination. Patient-reported, imaging, and safety measures should be selected as targeted complementary endpoints according to the population, intervention, and hypothesized mechanism. Conclusions: No single scale adequately captures recovery after EVT. A well-designed protocol should prespecify a clinically meaningful primary endpoint, usually the 90-day ordinal mRS, together with a focused set of early neurological, safety, supportive imaging, and selected patient-reported outcomes tailored to the target population and anticipated treatment effect. Keywords: acute ischemic stroke; endovascular thrombectomy; outcome assessment; modified Rankin Scale; NIH Stroke Scale; quality of life; patient-reported outcomes; clinical trials.
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7225437729