James E. Siegler, MD, Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, discusses two groundbreaking trials presented at the International Stroke Conference (ISC) 2023 that investigated the role of endovascular treatment (EVT) for ischemic stroke with a large ischemic core on non-contrast CT or perfusion imaging. The ANGEL-ASPECT (NCT04551664) and SELECT2 (NCT03876457) randomized, controlled trials investigated the efficacy of EVT compared to best medical management in patients with an ASPECT score of 3-5 or core volume of 70-100ml (ANGEL-ASPECT)/ ≥50ml (SELECT2) on CT perfusion/MRI, within 24 hours from last known well. Improved mRS scores at 90 days were seen with EVT use compared to BMM in both trials. These data are in line with prior evidence in the large core population. Several trials addressing this question are still underway (TENSION, NCT03094715; LASTE, NCT03811769). This interview took place during the International Stroke Conference (ISC) 2023 in Dallas, TX.

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