We read with great interest the meta-analysis by Qin et al 1 regarding the efficacy of endovascular treatment (EVT) in patients with acute anterior circulation large vessel occlusion and low National Institutes of Health Stroke Scale (NIHSS) scores. The study presents pivotal insights but also raises crucial concerns that we wish to address for a more nuanced understanding.

First, the study’s approach towards differentiating primary EVT from rescue EVT requires more precision. In the context of acute stroke management, these two interventions have distinct indications and outcomes. For example, in the study by Kim et al,2 the conflation of these two distinct types of EVT potentially confounds the results. In patients …