After carefully reading Marco Colasurdo et al’s work ‘Predictors for large vessel recanalization before stroke thrombectomy: the HALT score’,1 we commend the authors for bridging a significant gap in the body of knowledge. The creation of a multivariable recanalization prediction model for major vascular obstruction has important implications. This model can assist in avoiding delays related to imaging and intravenous thrombolysis (IVT) along with potential risks related to IVT for individuals with a low likelihood of recanalization.

However, we would like to share some concerns regarding this study. Notably, according to the HALT score, any patient with vertebrobasilar artery occlusion 1.5 hours post-thrombolysis has a score of 6 and therefore a 41.9% chance of recanalization. This rate does not reconcile with the rates of 13%,2 30%,3 0%,4 and 5%5 of recanalization reported in previous studies. This study also fails to include strong predictors of recanalization …