Endovascular Treatment for Ischemic Stroke:Identifying factors to improve outcome and alternative methods to evaluate treatment effect

Despite the overall treatment effect of EVT is highly effective, there are many targets to further improve patient outcomes. In this thesis, we identified factors influencing outcome after EVT and evaluated alternative approaches for study design to accelerate research on new therapeutic strategies. Based on our findings, we recommend to perform EVT under local anesthesia instead of conscious sedation if this is considered safe. Besides, large drops in periprocedural blood pressure should be avoided as these are associated with worse outcomes. Blood pressure on hospital admission is not an argument to withhold or delay EVT for ischemic stroke as blood pressure does not negate the effect of EVT. Furthermore, prevention of post-procedural adverse events has a great potential to further improve outcomes in successfully reperfused patients. A reduced infarct volume after EVT explains one third of treatment benefit in terms of neurological deficit. Development of new imaging techniques for accurate, reliable assessment of brain tissue viability is of importance to further improve both stroke research and clinical practice. Another future direction for EVT research is the use of cohorts of synthetic stroke patients for the development and validation of prediction tools, decision model analysis, and in-silico trials, as we demonstrated statistical methods to generate realistic cohorts of synthetic stroke patients.