Journal Club: Endovascular Therapy for Patients With Low NIHSS Scores and Large Vessel Occlusion in the 6- to 24-Hour Window

Endovascular therapy (EVT) has proven benefit for patients with anterior circulation large vessel occlusion (LVO) strokes with moderate-to-severe deficits, but its value in patients presenting 6-24 hours after onset with mild symptoms (NIH Stroke Scale score ≤5) remains unclear. This journal club article examines a retrospective analysis of CLEAR registry data comparing EVT with medical management in this patient subgroup. The authors used multivariable regression and sensitivity analyses to adjust for baseline differences but found no significant association between EVT and improved functional outcomes. Key takeaways for trainees include critical appraisal of nonrandomized data, interpretation of nonsignificant results, and understanding the role of adjusted models and sensitivity analyses in observational research. Limitations of this study include its retrospective, nonrandomized design and potential for selection bias. Until randomized trial data from ENDOLOW and MOSTE become available, treatment decisions should be individualized, incorporating imaging findings and clinical context.