Thrombectomy Selection in the Large Core Era: Implications for Regional Transfers

Area of Science:

• Neurology
• Interventional Neurology
• Stroke Medicine

Background:

• Large core strokes were previously considered poor candidates for endovascular therapy due to perceived high risks and limited benefits.
• Mechanical thrombectomy is the established treatment for large vessel occlusions with salvageable brain tissue.

Purpose of the Study:

• To review advancements in managing large core strokes.
• To focus on diagnostic imaging protocols for selecting patients eligible for endovascular therapy.

Main Methods:

• Review of recent randomized controlled trials.
• Analysis of diagnostic imaging protocols for patient selection.

Main Results:

• Recent trials demonstrate favorable outcomes with thrombectomy in large infarcts, contrary to previous assumptions.
• Mechanical thrombectomy is confirmed as the gold standard for large vessel occlusions with viable brain tissue.

Conclusions:

• Expanded patient selection criteria for endovascular therapy in large ischemic stroke are warranted.
• Optimizing treatment timing and exploring diverse management strategies are crucial for improving patient outcomes.