Complication and Endpoint Heterogeneity in Vascular Intervention Research: Lessons from Neurovascular Practice

Vascular intervention has advanced technically faster than it has matured methodologically. Across neurovascular, carotid, peripheral, and aortic practice, complications and outcomes are often reported using different definitions, thresholds, surveillance strategies, adjudication methods, follow-up schedules, and units of analysis. As a result, studies that appear to assess the same treatment may in fact be measuring different outcome constructs. This problem is particularly visible in neurovascular intervention, where technical, radiographic, and clinical outcomes are often combined within the same evaluative framework. In acute ischemic stroke thrombectomy, changes in reperfusion thresholds can alter the meaning of procedural success. In intracranial aneurysm treatment, angiographic occlusion, retreatment, delayed stenosis, and neurological morbidity are often reported together despite representing different dimensions of efficacy and safety, while the interpretation of surrogate angiographic outcomes may vary across device classes. Similar issues arise in carotid intervention, peripheral endovascular therapy, and endovascular aneurysm repair, where composite outcomes, imaging-detected complications, and inconsistent surveillance protocols further complicate interpretation. These variations limit cross-study comparability, weaken meta-analytic synthesis, and may distort judgments about treatment effectiveness and safety. Endpoint heterogeneity persists partly through disciplinary silos, device-driven evaluation frameworks, and regulatory pathways that favor surrogate over clinical endpoints; addressing it will require not only better reporting but standardized outcome constructs, coordinated international registries, and broader adoption of core outcome set methodology. Greater discipline in endpoint definition and reporting, together with broader adoption of standardized outcome frameworks and core outcome set methodology, is needed if evidence in vascular intervention is to accumulate coherently.