Neurointerventional Advances in 2023

Editorials large core stroke neuroIntervention stroke thrombectomy T his past year did not disappoint with major advancements in acute ischemic stroke (AIS) and intracranial hemorrhage (ICH) care across multiple domains.As we had anticipated in our previous annual summary, 1 the headliners in 2023 were a suite of trials examining the benefit of endovascular stroke therapy (EVT) in patients with large and established infarcts, building on the RESCUE JAPAN LIMIT (Recovery by Endovascular Salvage for Cerebral Ultra-Acute Embolism-Japan Large Ischemic Core Trial) of 2022. 2 These trials included SELECT2 (Randomized Controlled Trial to Optimize Patient's Selection for Endovascular Treatment in AIS), 3 ANGEL-ASPECT (Study of Endovascular Therapy in Acute Anterior Circulation Large Vessel Occlusive Patients With a Large Infarct Core), 4 and TENSION (Efficacy and Safety of Thrombectomy in Stroke With Extended Lesion and Extended Time Window). 5 Two other studies that have presented their results with publication pending are TESLA (Thrombectomy for Emergent Salvage of Large Anterior Circulation Ischemic Stroke) 6 and LASTE (Large Stroke Therapy Evaluation). 7SELECT2 randomized 352 patients across 31 centers to either EVT or medical management in patients with anterior vessel large-vessel occlusion and Alberta Stroke Program Early Computed Tomography Score (ASPECTS) of 3 to 5 or computed tomography (CT) perfusion core estimate >50 mL.The trial was stopped early, as the rate of functional independence [modified Rankin scale (mRS) score of 0-2] at 90 days in the EVT arm was