To provide a deep dive analysis of the malpractice allegations related to mechanical thrombectomy in the management of stroke.

Since 2015, several clinical trials have broadened the indications for the use of mechanical thrombectomy for acute stroke. Lowering treatment thresholds may serve as fodder for malpractice lawsuits if the claims relate to failure to provide treatment. Research in these allegations is limited. It is important for physicians caring for stroke patients to be aware of the reasons for potential malpractice claims. In this study, we evaluate for the most common plaintiff claims shared across multiple thrombectomy malpractice cases.

For this systematic review, we used the search terms ‘stroke’, ‘thrombectomy’ and ‘medical malpractice’ in the legal databases Google Scholar Case Law, Westlaw, and CaseText. We read 206 case files and identified 20 that were related to medical malpractice and stroke thrombectomy treatment. We collected data on characteristics including allegations, year of verdict, urban vs. rural hospital, and ruling. We then identified patterns of occurrences which generalized over multiple cases.

Most cases alleged failure to diagnose and timely treat (n=15;75%). Specifically, 4 patterns of physician actions formed the basis of plaintiffs’ arguments and were found in multiple cases: adherence to hospital protocol (n=8;40%), poor physician bedside manner (n=3;15%), failure to obtain imaging (n=15;75%), and failure to obtain expert consultation (n=14;70%). Case ruling was determined to be in favor of physician defendants (n=4;20%) patient plaintiffs (n=4;20%) or no final ruling (n=12;60%).

Our results identify specific and frequent patterns found in plaintiffs’ arguments against physicians caring for the stroke patient where thrombectomy is being considered.  Because stroke thrombectomy triage is becoming less selective, malpractice complaints of failure to image and treat may increase because there will be an expectation that even more patients should undergo thrombectomy.