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Review
. 2023 Dec 18;10(12):499.
doi: 10.3390/jcdd10120499.

Revolutionizing the Management of Large-Core Ischaemic Strokes: Decoding the Success of Endovascular Therapy in the Recent Stroke Trials

Gareth Zigui Lim  1 , Jonathan Yexian Lai  1 , Christopher Ying Hao Seet  1 , Carol Huilian Tham  1 , Narayanaswamy Venketasubramanian  2 , Benjamin Yong Qiang Tan  3   4 , Mingxue Jing  3   4 , Joshua Yee Peng Yeo  3   4 , May Zin Myint  3   4 , Ching-Hui Sia  4   5 , Hock Luen Teoh  3   4 , Vijay Kumar Sharma  3   4 , Bernard Poon Lap Chan  3   4 , Cunli Yang  3   6 , Andrew Makmur  3   6 , Shao Jin Ong  3   6 , Leonard Leong Litt Yeo  3   6
Affiliations
Review

Revolutionizing the Management of Large-Core Ischaemic Strokes: Decoding the Success of Endovascular Therapy in the Recent Stroke Trials

Gareth Zigui Lim et al. J Cardiovasc Dev Dis. .

Abstract

Endovascular therapy (EVT) has revolutionized the management of acute ischaemic strokes with large vessel occlusion, with emerging evidence suggesting its benefit also in large infarct core volume strokes. In the last two years, four randomised controlled trials have been published on this topic-RESCUE-Japan LIMIT, ANGEL-ASPECT, SELECT2 and TENSION, with overall results showing that EVT improves functional and neurological outcomes compared to medical management alone. This review aims to summarise the recent evidence presented by these four trials and highlight some of the limitations in our current understanding of this topic.

Keywords: CT; MRI; acute; endovascular treatment; ischaemic stroke; large infarcts; radiology.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
A large infarct core volume (LICV) stroke is demonstrated in this figure. There is a left middle cerebral artery territory (MCA) infarct with loss of grey–white differentiation in the left caudate, internal capsule, insula, M2 (A), as well as left M5 and M6 regions (B), giving an ASPECTS of 4. MRI brain shows corresponding DWI hyperintensities in the left MCA territory (C). CT perfusion imaging processed by RAPID software (v 1.3.3) shows the ischaemic core and perfusion deficit. The ischaemic core (pink) is 56 mL while the tissue at risk of infarction (green) is 103 mL, giving a large mismatch ratio of 1.8 (D). CT vessel angiogram shows a left M1 large vessel occlusion (E).
Figure 2
Figure 2
mRS 0–2 at 90 days and mortality at 90 days across the trials.
See this image and copyright information in PMC

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