Ten years after thrombectomy: how do we improve outcomes in the patients who still don’t benefit?

Mechanical thrombectomy has transformed stroke care, yet many clinicians still equate a lack of functional independence with treatment futility. In this session, Raul Nogueira explains how this perspective may be limiting access to beneficial therapy.

Benefit is not the same as good outcome

A central message emerging from recent evidence is that thrombectomy benefit should not be measured solely by achieving mRS 0-2. Patients with severe strokes, including large-core infarcts, may still experience meaningful reductions in disability even when complete independence is unlikely.

Why current selection paradigms need reconsideration

Several imaging markers are powerful prognostic tools, but they are not always reliable treatment effect modifiers. Factors such as age, infarct size, aspects or collateral status should not automatically exclude patients from endovascular therapy.

Key takeaways

• Absence of a good outcome does not equal absence of benefit.
• Large-core infarcts should not automatically preclude EVT.
• Imaging findings help estimate prognosis but have limited value for identifying patients who will not benefit.
• Clinical prediction remains highly imperfect.