• stroke
• thrombectomy

In response to the publication of the five positive stroke thrombectomy trials, the American Heart Association issued a focused update in 2015 of its guidelines for early management of patients with acute ischemic stroke, including the uncertainty of benefit of thrombectomy in patients with an Alberta Stroke Program Early CT Score (ASPECTS) <6 (level IIb), recommending further clinical trials.1

Investigators in many of these studies were trained to dichotomize ASPECTS scoring during enrollment. Doing so not only yielded higher interobserver agreement, particularly when a threshold of 7 was used, but also simplified and expedited enrollment.2 This may have inadvertently led to a more widespread trend in dichotomizing ASPECTS in clinical practice, with the presence or absence of evidence as justification.

In this month’s issue of JNIS, Mourand et al 3 challenge the ASPECTS <6 threshold by reporting their single center results of 60 stroke thrombectomy patients treated from 2009 to 2014 presenting with ASPECTS ≤5. Their results suggest that there may still be efficacy and safety with stroke thrombectomy in the presence of large core infarcts. Median admission National Institutes of Stroke Scale (NIHSS) score was 20 and median age was 66 years. Most patients were …