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Comment & Response
April 2018

Considerations in Assessing Disability Trajectories Before and After Stroke and Myocardial Infarction—Reply

Author Affiliations
  • 1Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
JAMA Neurol. 2018;75(4):518. doi:10.1001/jamaneurol.2018.0202

In Reply We agree with Pan et al that endovascular thrombectomy for large vessel occlusions may improve long-term disability trajectories for those who receive this treatment. However, few patients with ischemic stroke currently receive this treatment, and it is not certain how much of an association endovascular thrombectomy will have with long-term disability trajectories for patients with ischemic stroke as a whole. It is certainly hoped that more trained specialists are available to provide the treatment, more capable stroke centers will be developed, and more patients will present within an amenable time window. However, even with perfect availability of the intervention, it will only benefit those patients who have large vessel occlusion and not other subtypes or mechanisms of ischemic stroke. We also agree that frailty is an important concept with demonstrated associations with outcomes. However, we chose to focus on a more narrowly-defined construct—disability—as an outcome.

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