Sarraj A, Hassan AE, Savitz S, et al. - In this prespecified analysis of the Optimizing Patient’s Selection for Endovascular Treatment in Acute Ischemic Stroke trial, a prospective cohort study of imaging selection that was carried out in nine US comprehensive stroke centers, of individuals with moderate to severe stroke and anterior circulation large-vessel occlusion presenting up to 24 hours from the time they were last known to be well between January 2016 and February 2018, and followed them up for 90 days, researchers contrasted outcomes in individuals with large ischemic cores treated with endovascular thrombectomy (EVT) and medical management vs medical management alone. Nineteen of 62 individuals treated with EVT accomplished functional independence vs 6 of 43 treated with medical management (MM) only. Also, compared with MM, EVT was related to superior functional outcomes and smaller final infarct volume. A 42% decline per 10-cm³ rise in core volume and a 40% decrease per hour of treatment delay was noted in the odds of functional independence. Out of ten individuals who had EVT with core volumes greater than 100 cm³, none had a positive outcome. However, for individuals with large cores who receive EVT, the odds of good outcomes considerably decrease with rising core size and time to treatment, suggesting possible advantages.