Thrombectomy for Large-Volume Stroke with Simplified Imaging

Three recent trials showed varying degrees of benefit from endovascular thrombectomy (EVT) in ischemic stroke patients with a large volume (large core) of ischemic tissue at baseline. These studies relied on perfusion imaging to depict the core size, which involves contrast administration. Since perfusion imaging is not available at all centers, a simplified imaging protocol is of interest. These authors conducted a clinical trial at 41 centers in which patients with large-volume strokes, judged by ASPECTS (Alberta Stroke Program Early Computed Tomographic Score) on noncontrast computed tomography (CT) or diffusion-weighted imaging, were randomized to medical management (MM) alone or MM plus EVT. The primary endpoint was a shift on the modi…