On behalf of the large core trials principal investigators, immensely proud and honored to present primary results of the ATLAS IPD meta-analysis @ESOstroke with simultaneous publication in @TheLancet -thelancet.com/journals/lance… EVT not only improved outcomes compared to medical care, but functional independence and independent ambulation were also achieved in a meaningful proportion of patients. Additionally, EVT was life-saving, as one of the few reperfusion therapies to achieve it. With the exception of patients with very large core (volume ≥150 ml) in the late time window, where evidence is limited because of wide confidence intervals but benefit could not be excluded, EVT demonstrated consistent benefit regardless of ASPECTS and ischaemic core strata. Our deepest gratitude to the patients, their families, and all investigators and coordinators at the trial sites. A mammoth collective effort over 3 years from 6 trials with practice changing results that improve care for 20% LVOs! #stroke #EVT #largecore #NoLVOleftbehind @XiaochuanHuo @VCostalat @oozaidat @VYogendrakumar @deeppujara @dliebesk @ARazzakMD @NguyenThanhMD @samialkasab @AmeerEHassan @Michael3Abraham @FelixSun1230 @HiroshiYamagam2 @SunilAShethMD @Fie0815 @RaulNogueiraMD @rgrandhi @PascalJabbourMD @shazamhussain @dr_mchen @mihill68 @lapergue6 @TudorGJovin @AlbertJYoo

Trombectomía mecánica en ACV isquémico con core grande: el metaanálisis ATLAS (IPD) con 1886 pacientes de 6 RCTs (RESCUE-Japan LIMIT, ANGEL-ASPECT, SELECT2, TENSION, LASTE, TESLA) confirma beneficio contundente de la EVT. 1⃣ Desplazamiento favorable en mRS a 90 días: aGenOR 1.63 (IC95% 1.42–1.87; p<0.001). Independencia funcional (mRS 0-2): 19.5% EVT vs 7.5% MM (aRR 2.61). Deambulación independiente (mRS 0-3): 36.6% vs 19.8%. 2⃣ Reducción significativa de mortalidad con EVT: 31% vs 37% (aRR 0.82; IC95% 0.70–0.97; p=0.018). El beneficio neto supera el incremento de sICH (5.5% vs 2.7%, aRR 2.02; p=0.017). 3⃣ Beneficio consistente en todos los subgrupos clínicos e imagenológicos: edad, sexo, severidad (NIHSS), localización de oclusión (ACI/ACM), ventana temporal (<6h y 6–24h) y ASPECTS (incluyendo 0-2 en ventana temprana: aGenOR 3.03). 4⃣ El efecto terapéutico se mantiene con volúmenes de core isquémico <100 mL (aGenOR 1.75) y 100–149 mL (aGenOR 1.56), pero se pierde en cores ≥150 mL (aGenOR 0.96; p=0.895). Hallazgo clave para selección de pacientes. 5⃣ ATLAS establece la superioridad de la trombectomía sobre el manejo médico en esta población que representa ~1/5 de los pacientes con oclusión de gran vaso. La evidencia respalda expandir criterios de elegibilidad para EVT. #Trombectomía #StrokeIsquémico #LargeCore #ATLAS2025 #WorldStrokeCongress 📍 Clínica Ricardo Palma, Lima – Perú Dr. Manuel Moquillaza Valle Neurólogo Vascular e Intervencionista CMP 54060 / RNE 25595

I presented the latest advances in the management of large core ischemic stroke (ASPECTS ≤5) 🧠 @INNNMVS Current evidence shows that mechanical thrombectomy is not only safe but also improves functional independence and reduces mortality, even in these patients. Changing paradigms in stroke treatment 💪 #Stroke #Neurointervention #Thrombectomy #LargeCore #Medicine #Research

Thank you so much for highlighting our work! @Hopkins_Rad @HopkinsNsurg @HopkinsNCCU @hopkinsneurorad @hopkinsneurons #stroke #largecore #neuroimaging

Check out our latest paper highlighting the importance of #collaterals/HIR and initial stroke severity in #largecore #stroke! @Hopkins_Rad @hopkinsneurorad @RapidAI @JeremyHeitMDPHD @theAJNR_EIC @hamza_isleem @dhairyalakhani @aneribalar @liciapluna @francisdeng @janetymei

Acute carotid stenting for tandem lesions can be safe and effective in large core infarct patients per the ETIS registry investigators bit.ly/3YDQdo9 #stroke #thrombectomy #tandemlesion #largecore

Check out our latest paper in @StrokeAHA_ASA focusing on #largecore #LVO #stroke, demonstrating the value of CBV < 42%. In this study, we found that patients who underwent #EVT #MT, and in the entire cohort as well, that CBV < 42% >= 68 ml was associated with poor outcomes.

At the stroke/vascular session at #ASFNR24, we have a review of #largecore #stroke by ⁦@VincentTimpone⁩ and venous outflow by ⁦@JeremyHeitMDPHD⁩ coming up! ⁦@theASFNR⁩ #LVO #MeVO #VO

How much does first pass effect improve outcomes in large core thrombectomy patients? Huang et al provide the answer in this post-hoc analysis of the ANGEL-ASPECT trial data bit.ly/3YuZCOP #Stroke #Thrombectomy #LargeCore

Another large-core stroke treatment trial yielding positive results which is exciting news for the stroke community but comes with a huge responsibility on us as neurologists. Age, baseline medical conditions/functional status play a vital role but the most important factor would be patient wishes and alignment with their long-term goals. Ethically challenging when considering a mRS of a 4/5 over a 6. As one of my wonderful colleagues states, "the amount of time available to make the decision is so short compared to the time one or one's family has to live with the decision" Truer words were never spoken. Patient selection/wishes/long-term goals remain the key when these decisions are made in a span of minutes, but it is wonderful that we have additional options to treat debilitating strokes... #Stroke #Palliativemedicine #largecore #EVT #Thrombectomy #strokeawarenessmonth @HeartandStroke @American_Stroke

Published Large Core Trial Summary #stroke #LargeCore LASTE is published, waiting for TESLA: Trial of Thrombectomy for Stroke with a Large Infarct of Unrestricted Size | New England Journal of Medicine nejm.org/doi/full/10.1056/NE…

📣Atentos amigos y colegas!!! 👉Los dejamos invitados para nuestra última sesión de educación del año! 🗓️5 y 7 de Dic Con los temas 🔥🔥 de año y del último #WSC #AF #LargeCore #HIC #DOAC 🔜Atentos a link y horarios! @SIECV_IASO @WorldStrokeOrg

En Evento #Angels LATAM @carlosmictusvh recorriendo la evidencia “más allá del estado del arte” #tnk #rtpa #largecore

Wonderful discussing @SELECT2Trial results and implications with Dr. Johansen at the ANA podcast. Thoroughly enjoyed the high level scientific exchange and hope it made for an informative listening @JoeCarrera_MD @ANA_journals #stroke #largecore #NoLVOleftbehind

Does mechanical thrombectomy help stroke pts with #largecore ischemic stroke? The highly anticipated @SELECT2Trial will be presented soon by @amrsarrajMD #ISC23 #ISC2023

Debate #2 - EVT for Large Core ✅️ Not all #cores are the same ➡️ Clinical impact different in ASPECT 0-3 vs 4-5. Soon 3 RCTs will yield more results on how to handel LVO patients with #LargeCore @CerebrovascLab @StrokeCliTrials @svinsociety #SVINAM #SVIN2022

Endovascular Therapy for Acute #Stroke with a #LargeCore | NEJM nejm.org/doi/full/10.1056/NE… Many Congratulations to Drs Yoshimura, Sakai, Yamagami et al for Japan RESCUE Limit. 86% of patients selected with MRI. mRS ordinal shift favored EVT. @AlbertJYoo @oozaidat

3/ Here comes the big push to further expand the treatable #LVO population! #LargeCore #MedTwitter #Stroke @StrokeAHA_ASA

Dr Osama Zaidat @oozaidat @AlbertJYoo present an update on the TESLA #LargeCore #EVT randomized trial at #SVINAM clinical trials session.

Work on the making to improve imaging technology use and patient outcomes! Check out #Select2. pubmed.ncbi.nlm.nih.gov/3428… @amrsarrajMD @SELECT2Trial #Stroke #EVT #Select2 #LargeCore