Clinical Question
Should I do EVT for large-core stroke (low ASPECTS)?
Synthesises 5 trialsfive positive RCTs (2022–2024) reversing the small-core-only EVT paradigm
What does the guideline say?
- §4.7.2· 2026
In selected patients with AIS from anterior circulation proximal LVO of the ICA or M1, presenting between 6 and 24 hours from onset of symptoms, with age <80 years, NIHSS score ≥6, prestroke mRS score 0 to 1, ASPECTS 3 to 5, and without significant mass effect on imaging, EVT is recommended to improve functional clinical outcomes and reduce mortality (COR 1, LOE A). In selected patients with AIS from anterior circulation proximal LVO of the ICA or M1 presenting within 6 hours from onset of symptoms, with age <80 years, NIHSS score ≥6, prestroke mRS 0 to 1, ASPECTS 0 to 2, and without significant mass effect on imaging, EVT is reasonable to improve functional clinical outcomes and reduce mortality (COR 2a, LOE B-R).
Source: 2026 AHA/ASA Guideline · §4.7.2 (Anterior-circulation EVT eligibility, including large-core)
The trials cited in the guideline's supportive text appear below.
Trials in this question· 5
Related questions
Does my LVO patient need EVT?
early window, late window, large-core, and MeVO boundary
Perfusion imaging or non-contrast CT for late-window selection?
evolution from CT-perfusion / MRI mismatch (DAWN, DEFUSE-3) to plain-CT and MRI ASPECTS selection (RESCUE-Japan LIMIT, LASTE, SELECT2, ANGEL-ASPECT)
Does my MeVO or distal-occlusion patient benefit from EVT?
first two RCTs in medium-vessel and distal occlusions. Both define the negative end of EVT
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