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

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• Infarct detection relies heavily on imaging modality and infarction criteria.
• Recent large-core thrombectomy trials used varied imaging methods and inconsistent Alberta Stroke Program Early CT Score (ASPECTS) grading.
• This heterogeneity resulted in distinct trial populations, hindering data pooling.

Purpose of the Study:

• To propose a standardized approach for pooling data from large-core thrombectomy trials.
• To improve the clinical meaningfulness of pooled treatment effect estimates.
• To facilitate the dissemination of standardized imaging analysis into clinical practice.

Main Methods:

• Pooling trial data by imaging modality and time window.
• Re-adjudicating imaging using standardized criteria for analysis.
• Standardizing Alberta Stroke Program Early CT Score (ASPECTS) grading across trials.

Main Results:

• Heterogeneous imaging methods and inconsistent ASPECTS grading in recent trials led to distinct patient populations.
• Standardized data pooling by imaging modality and time window is necessary for meaningful analysis.
• Re-adjudication with standardized criteria will enable reliable pooling.

Conclusions:

• Standardized imaging analysis and data pooling are essential for large-core thrombectomy trials.
• A harmonized approach will allow for more accurate estimation of treatment effects.
• This standardization can guide real-world patient care and improve outcomes.