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Three recently published and highly publicized mechanical thrombectomy studies in the New England Journal of Medicine provide unprecedented level 1a stroke treatment evidence for acute large vessel occlusions.1–3 Whereas previously there was equipoise, treatment decisions now seem straightforward with less room for uncertainty and controversy. Furthermore, shortening the time to recanalization has been repeatedly shown to improve the odds for favorable outcomes. As a result, the process of informed consent might seem, at one extreme, to be an unnecessary time-wasting obstacle to effectively delivering mechanical thrombectomy. The very concept of informed consent for acute stroke has actually seen many iterative changes since the first clinical use of intravenous thrombolysis 20 years ago, to the multitude of subsequent acute stroke trials, and now to the present, when positive thrombectomy evidence exists.
Informed consent is certainly much more than simply convincing the patient or family member to sign the blank space. This documentation mostly serves to protect the physician4 and, more practically, must be in the chart before the procedure for hospitals to participate in the Medicare program and receive reimbursement.5 The actual ethical purpose, though, is patient protection via education. The three essential ideals consist of sufficient patient information, sufficient patient understanding, and being free from duress. In the …
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.