• Stroke

This edition of the Journal of Neurointerventional Surgery (JNIS) highlights, among other topics, the controversial issue of access to stroke care. The publication in 2015 of the positive, randomised trials has opened a Pandora's Box of sorts. The application of mechanical thrombectomy (MT) techniques, to which patients and under what circumstances, is monumentally important in maintaining public support in general and hospital support locally for these treatments. Broad application of MT, while theoretically attractive from a public health perspective, may actually hinder our societal efforts in validating the efficacy of MT.

Bhole et al1 specifically examined how the use of ‘top tier evidence’ standards impact the application of MT techniques by comparing, retrospectively, the success and associated complications in two cohorts of patients: those meeting these evidence standards and those that do not. This work identified factors that mediate the arguments both in support and against the broader application of MT. Most importantly, the authors reported the complications of MT in patients not meeting these strict evidence standards. Not unexpectedly, patients not meeting evidence standards had a higher mortality rate than …