Intensive care unit versus stroke unit admission after endovascular thrombectomy: a propensity score-weighted cohort study

Q: What are the key findings of this study?

Post-thrombectomy ICU admission was not associated with 90-day functional independence compared with stroke unit admission.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute ischemic stroke due to large vessel occlusion treated with endovascular thrombectomy (n=577). Intervention: Intensive care unit (ICU) admission vs. Stroke unit (SU) admission. Primary outcome: Functional independence at 90 days (modified Rankin Scale [mRS] 0-2) (OR 1.20, 95% CI 0.85-1.70, p=0.2).

Q: What does this research mean for the field?

Admission to a specialized stroke unit rather than an intensive care unit following endovascular thrombectomy is not associated with significant differences in 90-day functional independence or mortality. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Galia Karp; Sheizaf Shpilberg; Adi Shiloh; Farouq Alguyan; Yair Zlotnik; Yana Mechnik Steen; Evgeni Brotfain; Anat Horev

doi:10.3389/fneur.2026.1928251

November 13, 2026Frontiers in NeurologyOpen Access

Intensive care unit versus stroke unit admission after endovascular thrombectomy: a propensity score-weighted cohort study

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Key result

Post-thrombectomy ICU admission shows no functional benefit over stroke unit admission at 90 days.

OR 1.20
95% CI 0.85-1.70
P=0.2
n=577

Why the study?

The optimal admission setting after endovascular thrombectomy for acute ischemic stroke due to large vessel occlusion remains undefined, with limited comparative outcome data between intensive care units and specialized stroke units.

Does post-thrombectomy admission to an intensive care unit (ICU) compared to a specialized stroke unit (SU) improve 90-day functional independence (mRS 0-2) in adult patients with acute ischemic stroke undergoing endovascular thrombectomy?

Key Points

To evaluate whether initial post-thrombectomy admission to an intensive care unit versus a specialized stroke unit is associated with differences in functional outcomes and mortality.
Retrospective single-center cohort study of 577 consecutive adult patients undergoing endovascular thrombectomy between 2015 and 2023 at a tertiary stroke center.
Patients were categorized by initial admission setting: 339 (59%) admitted to the ICU and 238 (41%) to the specialized stroke unit.
Inverse probability of treatment weighting based on propensity scores was applied to adjust for baseline imbalances including age, baseline NIHSS, baseline ASPECTS, occlusion location, and stent implantation.
Unadjusted rates of 90-day functional independence (mRS 0–2) were 37% in the ICU group versus 36% in the stroke unit group; unadjusted 90-day mortality was 26% versus 29%, and in-hospital mortality was 20% versus 19%.
ICU patients presented with higher baseline stroke severity than stroke unit patients (median NIHSS 15 vs. 13, p < 0.001).
After inverse probability of treatment weighting adjustment, admission setting was not independently associated with 90-day functional independence (adjusted OR 1.20, 95% CI 0.85–1.70) or 90-day mortality (adjusted OR 0.85, 95% CI 0.60–1.20).

Study Design

Type

Cohort (n=577)

Blinding

Blinded outcome assessment

Multicenter

No

Structured PICO

Does post-thrombectomy admission to an intensive care unit (ICU) compared to a specialized stroke unit (SU) improve 90-day functional independence (mRS 0-2) in adult patients with acute ischemic stroke undergoing endovascular thrombectomy?

P

Population

577 adults (mean age 70 years, 48.5% female) with acute ischemic stroke due to large vessel occlusion undergoing endovascular thrombectomy at a single tertiary stroke center in Israel, followed for 90 days.

E

Exposure

Post-thrombectomy admission to an Intensive Care Unit (ICU) (n=339, 59%), providing continuous hemodynamic monitoring and organ support.

C

Comparator

Post-thrombectomy admission to a specialized Stroke Unit (SU) (n=238, 41%), providing structured neurological monitoring and stroke-specific multidisciplinary care under consistent institutional stroke care protocols.

O

Outcome

Functional independence at 90 days, defined as a modified Rankin Scale (mRS) score of 0–2, assessed by clinicians blinded to the post-thrombectomy admission setting.hard clinical

Main Result

Odds Ratio: 1.2 (95% CI 0.85–1.7)

Absolute Event Rate: 37% vs 36%

p-value: p=0.2

In patients undergoing endovascular thrombectomy for acute ischemic stroke, admission to a specialized stroke unit rather than an intensive care unit was not associated with differences in 90-day functional independence or mortality after propensity adjustment, suggesting stroke unit care may be a reasonable alternative to routine ICU admission in selected patients.

Limitations

Retrospective, non-randomized single-center observational design with potential for residual confounding
Potential confounding by secular trends over time as calendar time was not incorporated into the propensity model
Patient-level indications for ICU admission, subsequent unit transfers, and specific ICU-level interventions were not systematically documented
Not powered to evaluate specific high-risk subgroups such as patients with severe systemic instability
Lack of hospitalization cost data for formal economic comparison
Non-randomized admission setting with potential for residual confounding despite propensity weighting
Secular trends in EVT technique, workflow efficiency, or overall stroke care over time were not directly incorporated into the propensity model
Unmeasured clinical factors influencing triage decisions, transfers between units, and use of ICU-level interventions were not systematically documented
Single-center design not powered to evaluate specific high-risk subgroups (e.g., severe systemic instability)
Detailed cost data were unavailable for formal economic comparison

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Answers are grounded in this paper and cite their sources.

Implication

Stroke unit admission was not associated with worse 90-day outcomes after thrombectomy; leaves open whether routine ICU care improves outcomes in selected patients.

Abstract

Background and purpose Endovascular thrombectomy (EVT) is standard treatment for acute ischemic stroke due to large vessel occlusion. However, the optimal post-procedural admission setting remains undefined. While many centers routinely admit patients to intensive care units (ICUs), others utilize specialized stroke units (SUs). Comparative outcome data are limited. We aimed to evaluate whether post-thrombectomy admission setting (ICU vs. SU) is associated with differences in clinical outcomes Methods We conducted a retrospective cohort study of consecutive adult patients undergoing EVT between 2015 and 2023 at a tertiary stroke center. Institutional policy evolved over time, resulting in natural variation in ICU and SU admissions. The primary outcome was functional independence at 90 days (modified Rankin Scale [mRS] 0–2). Secondary outcomes included 90-day mortality, in-hospital mortality, and symptomatic intracranial hemorrhage. To adjust for baseline differences, we applied inverse probability of treatment weighting (IPTW) based on propensity scores rather than propensity score matching, in order to retain the full cohort and maximize statistical efficiency Results Among 577 patients, 339 (59%) were admitted to ICU and 238 (41%) to SU. ICU patients had higher baseline stroke severity (median NIHSS 15 vs. 13, p < 0.001). Unadjusted rates of functional independence (37% vs. 36%), 90-day mortality (26% vs. 29%), and in-hospital mortality (20% vs. 19%) were similar between groups. After IPTW adjustment, admission setting was not independently associated with functional independence (adjusted OR 1.20; 95% CI 0.85–1.70), 90-day mortality (adjusted OR 0.85; 95% CI 0.60–1.20), or in-hospital mortality Conclusion Post-thrombectomy admission setting was not significantly associated with functional independence or mortality after adjustment for baseline differences. These findings suggest that, in selected patients within a tertiary stroke center, admission to a specialized stroke unit may be a reasonable alternative to routine ICU admission following EVT. Further prospective studies are needed to identify which patients can be safely managed outside the ICU.

Discussion

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Cite This Study

Karp et al. (2026) conducted a cohort in Acute ischemic stroke due to large vessel occlusion treated with endovascular thrombectomy (n=577). Intensive care unit (ICU) admission vs. Stroke unit (SU) admission was evaluated on Functional independence at 90 days (modified Rankin Scale [mRS] 0-2) (OR 1.20, 95% CI 0.85-1.70, p=0.2). Post-thrombectomy ICU admission was not associated with 90-day functional independence compared with stroke unit admission.

synapsesocial.com/papers/6af88c410e4d8f4b089c1ae0 https://doi.org/10.3389/fneur.2026.1928251

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Intensive care unit versus stroke unit admission after endovascular thrombectomy: a propensity score-weighted cohort study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Intensive care unit versus stroke unit admission after endovascular thrombectomy: a propensity score-weighted cohort study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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