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Peer-reviewedCC BY-NCStroke (Hoboken, N.J.)

Endovascular Stroke Thrombectomy for Patients With Concomitant Head Trauma: A Propensity Score–Matched and Machine Learning Study

  • Huanwen Chen1
  • Marco Colasurdo2
  • Matthew K McIntyre3
  • Adam Awad4
  • Dhairya A Lakhani5
  • Ajay Malhotra6
  • Dheeraj Gandhi1
6 affiliations
  1. 1Department of Neurosurgery (H.C., D.G.), University of Maryland Medical Center, Baltimore.
  2. 2Department of Interventional Radiology (M.C.), Oregon Health and Science University, Portland.
  3. 3Department of Neurosurgery (M.K.M.), Oregon Health and Science University, Portland.
  4. 4Department of Neurology (A.A.), University of Maryland Medical Center, Baltimore.
  5. 5Department of Neuroradiology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown (D.A.L.).
  6. 6Department of Radiology, Yale New Haven Hospital, New Haven, CT (A.M.).
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Abstract

Background

The safety and efficacy of endovascular thrombectomy (EVT) for patients with large vessel occlusion stroke presenting with concomitant head trauma is unclear.Methods

Using the Nationwide Readmissions Database in the United States (2016-2022), we identified adults with nonelective admissions for large vessel occlusion stroke and concurrent head trauma. Patients who underwent EVT were compared with patients who did not undergo EVT using 1:1 propensity score matching. A causal forest machine learning model was deployed to estimate individual-level conditional average treatment effects for excellent neurological outcomes, with Shapley Additive Explanation values quantifying variable importance.Results

Of 15 527 patients with large vessel occlusion stroke large vessel occlusion stroke with concomitant head trauma (median age, 78 years; 52.6% female; 51.6% with superficial injury), 2750 (17.7%) received EVT; propensity score matching yielded 2616 balanced pairs. After matching, EVT was associated with significantly higher rates of excellent outcomes (19.0% versus 13.7%; P=0.002) with no difference in mortality (14.6% versus 14.7%; P=0.93). In causal forest analysis, younger age, higher National Institutes of Health Stroke Scale score, lack of intravenous thrombolysis, and lack of altered mental status emerged as the strongest drivers of larger treatment benefit, and patients were dichotomized into EVT-favorable (n=8097) and EVT-unfavorable (n=7430) subgroups. In the favorable subgroup, EVT was associated with higher routine discharge (25.7% versus 21.5%; P=0.01); in the unfavorable subgroup, EVT conferred no benefit in routine discharge (10.0% versus 11.7%; P=0.26) but was associated with higher mortality (19.0% versus 14.0%; P=0.004).Conclusions

EVT is overall associated with higher rates of favorable discharge outcomes; however, treatment effect heterogeneity is substantial.

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Cite

BibTeXRIS
BibTeX
@article{chen2026endovascular,
  title = {{Endovascular Stroke Thrombectomy for Patients With Concomitant Head Trauma: A Propensity Score–Matched and Machine Learning Study}},
  author = {Huanwen Chen and Marco Colasurdo and Matthew K McIntyre and Adam Awad and Dhairya A Lakhani and Ajay Malhotra and Dheeraj Gandhi},
  journal = {Stroke (Hoboken, N.J.)},
  year = {2026},
  month = sep,
  doi = {10.1161/svin.126.002448},
  url = {https://europepmc.org/article/PMC/PMC13727205},
  note = {CC BY-NC},
}
RIS
TY  - JOUR
TI  - Endovascular Stroke Thrombectomy for Patients With Concomitant Head Trauma: A Propensity Score–Matched and Machine Learning Study
AU  - Huanwen Chen
AU  - Marco Colasurdo
AU  - Matthew K McIntyre
AU  - Adam Awad
AU  - Dhairya A Lakhani
AU  - Ajay Malhotra
AU  - Dheeraj Gandhi
PY  - 2026
DA  - 2026/09/10
JO  - Stroke (Hoboken, N.J.)
DO  - 10.1161/svin.126.002448
UR  - https://europepmc.org/article/PMC/PMC13727205
AB  - Background  The safety and efficacy of endovascular thrombectomy (EVT) for patients with large vessel occlusion stroke presenting with concomitant head trauma is unclear.Methods  Using the Nationwide Readmissions Database in the United States (2016-2022), we identified adults with nonelective admissions for large vessel occlusion stroke and concurrent head trauma. Patients who underwent EVT were compared with patients who did not undergo EVT using 1:1 propensity score matching. A causal forest machine learning model was deployed to estimate individual-level conditional average treatment effects for excellent neurological outcomes, with Shapley Additive Explanation values quantifying variable importance.Results  Of 15 527 patients with large vessel occlusion stroke large vessel occlusion stroke with concomitant head trauma (median age, 78 years; 52.6% female; 51.6% with superficial injury), 2750 (17.7%) received EVT; propensity score matching yielded 2616 balanced pairs. After matching, EVT was associated with significantly higher rates of excellent outcomes (19.0% versus 13.7%; P=0.002) with no difference in mortality (14.6% versus 14.7%; P=0.93). In causal forest analysis, younger age, higher National Institutes of Health Stroke Scale score, lack of intravenous thrombolysis, and lack of altered mental status emerged as the strongest drivers of larger treatment benefit, and patients were dichotomized into EVT-favorable (n=8097) and EVT-unfavorable (n=7430) subgroups. In the favorable subgroup, EVT was associated with higher routine discharge (25.7% versus 21.5%; P=0.01); in the unfavorable subgroup, EVT conferred no benefit in routine discharge (10.0% versus 11.7%; P=0.26) but was associated with higher mortality (19.0% versus 14.0%; P=0.004).Conclusions  EVT is overall associated with higher rates of favorable discharge outcomes; however, treatment effect heterogeneity is substantial.
SN  - 2694-5746
ER  -