IVT Before EVT Leads to Greater Chance of Good Outcomes Than Does EVT Alone

Background: Patients with acute ischemic stroke (AIS) caused by large vessel occlusion (LVO) with a large infarct core (LIC) (Alberta Stroke Program Early CT Score [ASPECTS], 0 to 5) were historically excluded from endovascular thrombectomy (EVT) randomized controlled trials (RCTs) due to their smaller proportion of salvageable tissue and higher risk of symptomatic intracerebral hemorrhage (sICH) and death. The Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism Japan Large Ischemic Core Trial (RESCUE-Japan LIMIT) showed the efficacy of EVT in these patients when performed either within the first 6 hours after stroke onset or within 6 to 24 hours after onset when initial fluid-attenuated inversion recovery imaging showed no abnormalities. Other trials have confirmed the benefits of EVT in these patients when performed within 24 hours of stroke onset. Research trials have shown no apparent benefit of additional IV thrombolysis (IVT) in patients with ASPECTS 3 to 5, and more...