TY - JOUR T1 - SELECTion criteria for large core trials: dogma or data? JF - Journal of NeuroInterventional Surgery JO - J NeuroIntervent Surg SP - 500 LP - 504 DO - 10.1136/neurintsurg-2021-017498 VL - 13 IS - 6 AU - Amrou Sarraj AU - Bruce Campbell AU - Marc Ribo AU - Muhammad Shazam Hussain AU - Michael Chen AU - Michael G Abraham AU - Maarten G Lansberg AU - Vitor Mendes Pereira AU - Spiros Blackburn AU - Clark W Sitton AU - Ronald F Budzik AU - Natalia Pérez de la Ossa AU - Juan F Arenillas AU - Teddy Wu AU - Jordi Blasco AU - Michael Mullen AU - Joanna Schaafsma AU - Jenny P Tsai AU - Navdeep Sangha AU - Osman Kozak AU - Daniel Gibson AU - Steven Warach AU - Dennis Cordato AU - Nathan W Manning AU - Timothy J Kleinig AU - Jean-Marc Olivot AU - Lucas Elijovich AU - Georgios Tsivgoulis AU - Andrei Alexandrov AU - Pascal Jabbour AU - Bernard Yan AU - Scott E Kasner AU - Adam S Arthur AU - Mark Parsons AU - James C Grotta AU - Ameer E Hassan AU - Gregory W Albers A2 - , Y1 - 2021/06/01 UR - http://jnis.bmj.com/content/13/6/500.abstract N2 - We thank the Editors of JNIS for alerting us in advance to the concerns about SELECT2 raised by Jadhav1 and colleagues and appreciate the opportunity to explain the rationale for the study design and clarify the benefits of including perfusion imaging-based selection criteria. We are confident that SELECT2 will provide high-level, reliable data regarding the safety and efficacy of endovascular thrombectomy (EVT) for large core patients.The choice of imaging modality for identifying large core in acute ischemic stroke remains an area of considerable debate. Magnetic resonance imaging (MRI) diffusion-weighted imaging (DWI), computed tomography (CT) or MR perfusion imaging and Alberta Stroke Program Early CT Score (ASPECTS) have all been proposed and studied. At present, there is no clear consensus on which imaging modality is best for identifying patients with large core. It is important to recognize that the early window randomized EVT trials used a broad range of imaging selection criteria. The imaging selection criteria for the initial five pivotal trials ranged from allowing patients to be enrolled regardless of the degree of early infarct signs,2 to studies that required a specific ASPECTS score range in addition to other imaging criteria,3–5 to EXTEND IA6 where the ASPECTS score was not considered, and CT perfusion (CTP) mismatch with a maximum estimated core size was required. All five trials were successful but with substantial variability in the treatment effect, leaving uncertainty as to the optimal imaging approach as well as whether there are patient subgroups who do not benefit. In fact, those utilizing perfusion mismatch criteria (EXTEND-IA, SWIFT PRIME) had higher rates of modified Rankin Scale (mRS) scores 0–2 and larger treatment effects, compared with other trials.2–6 Even if a treatment has a clear benefit in most patients, there can be important subgroups that do not … ER -