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ESOC 2022 | Endovascular therapy vs. medical management for large core ischemic stroke

Endovascular therapy (EVT) is the gold standard treatment option for patients with acute ischemic stroke with large vessel occlusion. Current guidelines restrict its use to patients with a small core on baseline imaging and high NIH stroke scale score. Ischemic core volume is widely employed as a key decision driver in acute stroke, based on the assumption that those with large cores are less likely to have salvageable tissue that would benefit from reperfusion. However, around 2/3rds of patients with a large core have mismatch. Pierre Seners, MD, PhD, Rothschild Foundation Hospital, Paris, France, shares the findings of a retrospective, observational study investigating the use of EVT compared to best medical management for large core patients. While EVT showed no benefit over medical management for patients without mismatch, there was a significant benefit for those with mismatch, despite a higher risk of intracranial bleeding. These findings highlight the importance of accurately measuring the ischemic tissue with perfusion imaging to identify those with reversible damage. This interview took place at European Stroke Organisation Conference 2022 in Lyon, France.