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Background To monitor endovascular and surgical care quality, the US Agency of Healthcare Research and Quality (AHRQ) has established a “failure-to-rescue” safety metric - Patient Safety Indicator (PSI) 04: Death Rate among Surgical Inpatients with Serious Treatable Complications. While a useful metric for elective procedures, PSI 04 is also applied to emergent endovascular thrombectomy (EVT) for acute ischemic stroke, which has a high rate of unavoidable mortality due to the presenting stroke.Methods PSI 04 rates after endovascular thrombectomy for stroke were identified by analysis of the Nationwide Inpatient Sample. Consecutive cases of EVT at a Comprehensive Stroke Center (CSC) were reviewed in detail after receiving a PSI 04 safety concern finding.Results The national event frequency for PSI 04 across all endovascular/surgical procedures was 14.3%, one to three orders of magnitude higher than for the other 18 PSIs, having a median 0.10% (IQR 0.10%–0.40%). The national event rate of PSI 04 for EVT was even higher at 20.5%. At the CSC, EVTs accounted for 7.2% of neurosurgical PSI 04 findings but represented only 1.5% of neurosurgical procedures. Analysis of consecutive EVT cases coded as PSI 04 revealed that all patient deaths were related to complications of the index stroke, not the EVT procedure.Conclusion AHRQ Patient Safety Indicator-4 does not identify preventable events among EVT patients and misleadingly suggests poor quality of care in hospitals having high EVT volume. To avoid discouraging institutions from pursuing EVT or incorrectly profiling their safety performance, PSI 04 should be revised.