{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T10:10:53Z","timestamp":1790071853433,"version":"4.0.1"},"reference-count":71,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"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:p>This structured narrative review evaluates endovascular thrombectomy (EVT) through an author-developed, population-level treatment\u2013response framework. In this framework, treatment response is the causal contrast between EVT plus best medical care and best medical care alone on a specified patient-centered outcome; it is not the outcome observed after EVT, and it cannot be observed for an individual patient because the untreated counterfactual is unknown. The framework is an evidence-interpretation tool, not a statistical estimator, a validated decision aid, or an individual prediction model. It separates four clinically actionable questions: first, trial eligibility\u2014does the patient resemble a population in which EVT was tested; second, baseline prognosis\u2014which features predict outcome under either strategy; third, procedural feasibility and safety\u2014can reperfusion be achieved promptly at acceptable risk; and fourth, treatment-effect modification\u2014does randomized evidence support a different relative or absolute effect across levels of a baseline variable? We conducted targeted, purposive searches across PubMed\/MEDLINE, supplemented by backward and forward citation tracking, to identify pivotal randomized trials, individual participant data meta-analyses, population-specific guidelines, and directly relevant secondary analyses through 15 August 2026. Randomized evidence supports EVT for proximal anterior-circulation large-vessel occlusion in the early window, selected 6\u201324\u202fh anterior-circulation populations, trial-defined large-core infarction, and selected moderate-to-severe basilar artery occlusion. Dedicated randomized evidence remains absent beyond 24\u202fh and incomplete for large-vessel occlusion with a low National Institutes of Health Stroke Scale (NIHSS) score. ESCAPE-MeVO, DISTAL, and DISCOUNT did not demonstrate average functional benefit in broad medium\/distal-vessel populations, whereas ORIENTAL-MeVO reported benefit in an enriched population with NIHSS at least 6; these results should not be generalized across all distal occlusions. Failure to detect an interaction does not establish homogeneous effects because interactions are outcome- and scale-specific, and most EVT trials are underpowered to detect them. Poor outcomes after successful reperfusion are descriptive of post-treatment states, not proof that EVT was futile. This framework clarifies what randomized evidence establishes, what remains prognostic or procedural, and where prospective testing is still required.<\/jats:p>","DOI":"10.3389\/fneur.2026.1951552","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T09:45:38Z","timestamp":1790070338000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A treatment-response framework for interpreting endovascular thrombectomy evidence: established practice, boundary expansion and unresolved frontiers"],"prefix":"10.3389","volume":"17","author":[{"given":"Naibijiang","family":"Abuliezi","sequence":"first","affiliation":[{"name":"The Second Affiliated Hospital of Xinjiang Medical University","place":["Urumqi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiale","family":"Zhao","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Xinjiang Medical University","place":["Urumqi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yihan","family":"Sun","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Xinjiang Medical University","place":["Urumqi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tayier","family":"Tuersong","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The Second Affiliated Hospital of Xinjiang Medical University","place":["Urumqi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyi","family":"Dun","sequence":"additional","affiliation":[{"name":"The Fifth Affiliated Hospital of Xinjiang Medical University","place":["Urumqi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qinfen","family":"Wu","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Xinjiang Medical University","place":["Urumqi, China"]},{"name":"Xinjiang Key Laboratory of Neurological Disorder Research (Lab No.: XJDX1711)","place":["Urumqi, China"]},{"name":"Xinjiang Clinical Research Center for Neurological Diseases","place":["Urumqi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"973","DOI":"10.1016\/S1474-4422(24)00369-7","article-title":"Global, regional, and national burden of stroke and its risk factors, 1990-2021: a systematic analysis for the global burden of disease study 2021","volume":"23","year":"2024","journal-title":"Lancet Neurol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1723","DOI":"10.1016\/S0140-6736(16)00163-X","article-title":"Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised 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