Review of Current Large Core Volume Stroke Thrombectomy Clinical Trials: Controversies and Progress

Area of Science:

• Neurology
• Interventional Radiology
• Clinical Trials

Background:

• Endovascular treatment (EVT) is established for acute ischemic stroke with small infarcts.
• Emerging evidence suggests potential benefits of EVT for patients with large infarct core volume (LICV).

Purpose of the Study:

• To review and compare the designs of six ongoing randomized clinical trials investigating EVT for acute ischemic stroke in patients with LICV.
• To highlight key differences in trial criteria that may influence outcomes and interpretation of results.

Main Methods:

• Comparative review of six independent randomized clinical trials.
• Analysis of trial designs, focusing on inclusion criteria related to LICV definition, imaging modalities, Alberta Stroke Program Early CT Scores, mismatch criteria, and treatment windows.

Main Results:

• Significant heterogeneity exists across the six trials in defining LICV and selecting patient populations.
• Variations include imaging techniques, specific Alberta Stroke Program Early CT Score ranges (0-5 vs. 3-5), mismatch criteria, and early/late window inclusion.

Conclusions:

• Understanding these design differences is critical for interpreting forthcoming trial results.
• Pooled analysis of trial data may be necessary to fully elucidate the efficacy of EVT in patients with LICV.
• Trial outcomes could impact current acute ischemic stroke treatment guidelines.