Addressing Heterogeneity in the Large-Core Trials: A Case for Standardized Imaging Analysis

Infarct detection is critically dependent on the imaging modality that is used and the criteria for defining tissue infarction. The recent trials of large-core thrombectomy used heterogeneous imaging methods to identify patients with large ischemic cores. Moreover, the Alberta Stroke Program Early CT Score methodology was not harmonized between the trials. Consequently, the large-core trial populations were distinct. To pool the populations in a clinically meaningful way, data should be pooled by imaging modality and time window. The imaging should be re-adjudicated using standardized criteria for imaging analysis and Alberta Stroke Program Early CT Score grading. This standardized approach can be disseminated into clinical practice so that the pooled treatment effect estimates can guide real-world patient care.