In Stroke, When Is a Good Outcome Good Enough?

In this issue of the Journal, Yoshimura and colleagues(1) report the favorable results of a well-conducted randomized trial comparing mechanical thrombectomy (endovascular therapy) with medical care in patients with large-vessel occlusion and large cerebral infarctions. Previous trials of endovascular therapy in selected populations of patients with small and medium-sized strokes have shown beneficial treatment effects, thereby setting the stage for randomized trials of endovascular therapy in patients with large infarctions.(2) Neurologists have been reluctant to perform endovascular therapy in patients with large infarctions because of the putative risk of bleeding into the infarction and the likelihood that outcomes would be . . .