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Endovascular thrombectomy has traditionally been offered to carefully selected stroke patients with relatively small infarct cores. Evidence from trials such as SELECT2, RESCUE-Japan LIMIT, ANGEL-ASPECT and related studies has expanded the treatment population to include some patients with large ischemic cores. A 2024 standards and guidelines statement from the Society of NeuroInterventional Surgery synthesised the emerging evidence and concluded that selected patients with anterior-circulation large-vessel occlusion and large infarct cores can benefit from thrombectomy within 24 hours. The recommendations emphasise factors such as age, NIHSS, baseline disability, imaging features and treatment timing rather than using infarct-core size alone as an absolute exclusion. For HCPs, the practical implication is major: systems should avoid therapeutic nihilism when a patient presents with a large established infarct but still has a treatable occlusion and a profile matching the evidence base. Selection should remain rigorous, and local stroke pathways need rapid imaging and specialist review. The topic directly matches IANCON's “grey zones” in vascular neurology and evolving endovascular treatment.
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Endovascular thrombectomy has traditionally been offered to carefully selected stroke patients with relatively small infarct cores. Evidence from trials such as SELECT2, RESCUE-Japan LIMIT, ANGEL-ASPECT and related studies has expanded the treatment population to include some patients with large ischemic cores. A 2024 standards and guidelines statement from the Society of NeuroInterventional Surgery synthesised the emerging evidence and concluded that selected patients with anterior-circulation large-vessel occlusion and large infarct cores can benefit from thrombectomy within 24 hours. The recommendations emphasise factors such as age, NIHSS, baseline disability, imaging features and treatment timing rather than using infarct-core size alone as an absolute exclusion. For HCPs, the practical implication is major: systems should avoid therapeutic nihilism when a patient presents with a large established infarct but still has a treatable occlusion and a profile matching the evidence base. Selection should remain rigorous, and local stroke pathways need rapid imaging and specialist review. The topic directly matches IANCON's “grey zones” in vascular neurology and evolving endovascular treatment.
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