{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T04:59:27Z","timestamp":1785387567010,"version":"3.55.0"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Endovascular thrombectomy (EVT) is an established treatment for selected patients with acute ischemic stroke caused by large-vessel occlusion (LVO). Single-center registries remain useful for reviewing outcomes, safety events, and workflow in routine care provided that their analytic limits are clearly stated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We performed a retrospective analysis of a single-center mechanical thrombectomy registry covering January 2023 to December 2025. The final cohort included 212 patients; 90-day modified Rankin Scale (mRS) data were available in 206 (97.2%). The primary outcome was functional independence at 90 days (mRS 0\u20132). Procedural and safety outcomes were summarized for the full cohort. Two pre-specified logistic regression models were used to explore clinical and procedural correlates and were interpreted with explicit caution regarding sample size and events-per-variable limitations. Robustness was assessed using (i) Firth penalized maximum-likelihood estimation, (ii) an anterior-circulation-only sensitivity Model 1, (iii) E-value computation and inverse-probability-of-treatment weighting for the intravenous thrombolysis (IVT) association, (iv) four-scenario handling of missing 90-day mRS including multiple imputation by chained equations, (v) optimism-corrected area under the curve (AUC) with 2,000-iteration bootstrap, and (vi) a\n                      <jats:italic>post-hoc<\/jats:italic>\n                      Model 1 incorporating collateral circulation score.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among patients with available 90-day follow-up, 111 of 206 (53.9%) achieved functional independence; across alternative handling of the 6 patients with missing follow-up, the proportion ranged from 52.4% (worst-case) to 55.2% (best-case), with multiple imputation yielding 53.3%. Baseline NIHSS score showed the most consistent adjusted association with lower odds of functional independence [Model 1: adjusted odds ratio (aOR) 0.95, 95% CI 0.91\u20130.99; Firth aOR 0.95, 95% CI 0.91\u20130.99]. Intravenous thrombolysis before thrombectomy showed a numerical adjusted association with functional independence (Model 1 aOR 2.14, 95% CI 1.11\u20134.13; Firth aOR 2.04, 95% CI 1.09\u20133.91). This magnitude is much larger than randomized-trial pooled estimates (relative risk approximately 1.05\u20131.15) and is best explained by confounding by indication. The E-value of 2.10 for the point estimate (1.29 for the lower confidence bound) indicates that a moderately strong unmeasured confounder could explain the observed association. In an anterior-circulation-only sensitivity analysis (\n                      <jats:italic>n<\/jats:italic>\n                      = 171), the IVT association no longer reached statistical significance (aOR 2.02, 95% CI 0.98\u20134.17), reflecting both reduced statistical power and territory-dependent case mix. Overlap weighting, which achieved exact balance on all measured propensity-score covariates whereas standard inverse-probability-of-treatment weighting did not (residual onset-to-door SMD = 0.74), produced an attenuated IVT aOR of 1.88 (95% CI 0.58\u20136.09)\u2014no longer statistically significant and close to the pooled randomized-trial effect size. No workflow or procedural variable reached statistical significance after adjustment. Apparent discrimination was moderate (C-statistic: Model 1, 0.679; Model 2, 0.703); optimism-corrected AUC was 0.60 for both models, the expected pattern of overfitting in low-EPV settings. Despite a TICI 2b\u22123 reperfusion rate of 99.5%, 45.9% of reperfused patients failed to achieve functional independence\u2014a\n                      <jats:italic>reperfusion\u2013outcome gap<\/jats:italic>\n                      that mirrors the increasingly recognized phenomenon of clinically ineffective reperfusion.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this single-center retrospective registry, baseline stroke severity was the most consistent clinical correlate of 90-day functional independence after mechanical thrombectomy, holding up across Firth-penalized, anterior-circulation-only, and collateral-adjusted sensitivity analyses. The IVT association lost statistical significance under overlap weighting (aOR 1.88, 95% CI 0.58\u20136.09), which we read as confounded rather than causal and which brings the present registry in line with the small randomized-trial effect size. Procedural success was exceptionally high yet decoupled from functional recovery in nearly half of patients. The data are best viewed as a local EVT benchmark and as a basis for quality review, including continued attention to door-to-EVT workflow and to mechanisms of futile reperfusion.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1835315","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T04:21:24Z","timestamp":1785385284000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical correlates, procedural benchmarks, and reperfusion\u2013outcome dissociation after mechanical thrombectomy for acute large-vessel occlusion stroke: a single-center retrospective registry study"],"prefix":"10.3389","volume":"17","author":[{"given":"Hao","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Neurology, Haining People's Hospital","place":["Jiaxing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhouming","family":"Ren","sequence":"additional","affiliation":[{"name":"Department of Neurology, Haining People's Hospital","place":["Jiaxing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinzheng","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Haining People's Hospital","place":["Jiaxing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuyan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Haining People's Hospital","place":["Jiaxing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1723","DOI":"10.1016\/S0140-6736(16)00163-X","article-title":"HERMES Collaborators. 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