Mechanical thrombectomy (MT) is the most effective therapy for acute ischemic stroke (AIS) caused by large vessel occlusion (LVO).¹ However, the functional outcome and mortality in patients after MT depend on many factors other than those directly associated with the procedure, such as time to recanalization and initial neurological and neuroimaging characteristics, including collateral sufficiency or the postprocedural reperfusion effect. On qualification, a physician weighs the potential benefits and risks of MT, which is especially important in older patients or those with extensive comorbidities, fragility syndrome, and other dysfunctions cumulative to individual medical burden.

Chronic kidney disease (CKD) affects as many as 8%–16% of the world’s population. In this issue of Polish Archives of Internal Medicine, Sawczyńska et al² published a multivariate analysis of 593 patients, including 59 with CKD, showing that CKD was not independently associated with short- or long‑term outcomes of MT. Despite some limitations, such as incomplete prestroke mRS in the CKD group or a low proportion of patients with stage 4–5 kidney failure, this report, in combination with other relevant data, indeed supports the thesis that CKD cannot be simply considered a contraindication to MT. This, however, does not mean that the condition can be ignored in decision making in such clinical setting. New analytical approaches that use artificial intelligence and deep‑learning methods combine multiple reports like this into a major database to weigh the significance of individual risk factors, define relations among them, and take into account their severity.^3,4

Evolution of the eligibility criteria for thrombectomy in AIS is not very different from that observed for many other procedures in clinical medicine. They were first relatively narrow, especially regarding a short time from stroke onset to the intervention. Then they expanded beyond these therapeutic windows to include the patients who were assessed to have “potentially survivable tissue” on specific neuroimaging (a relatively small sample).^5,6 Nowadays, it is assumed that even patients with large ischemic core or multiple comorbidieties might benefit from recanalization up to 24 hours.⁷ However, we must be more specific and use advanced tools to identify the patients in this cohort in whom thrombectomy is futile and may only augment their discomfort. The more reports on single risk factors are available for further meta‑analyses, the more personal and precise stratification applications we can set up.