Evidence with Recent Stroke Trails: The Role of Neuroimaging – What Radiologists Need to Know (2026)-WEB0225-2026

Video Transcription

Video Summary

This RSNA webinar, hosted by neuroradiologist Anshula Bhagal, focused on how neuroimaging is shaping treatment decisions in acute ischemic stroke, especially after recent thrombectomy trials. Dr. Gustavo Mendez reviewed large core stroke trials, explaining ASPECTS and perfusion-based definitions of core infarct, then summarized evidence showing thrombectomy improves 90-day outcomes compared with medical therapy, even in patients with large infarcts. However, only a minority achieved functional independence, and many important groups remain underrepresented in the trials, including older patients and those with very large cores. He emphasized that large core should no longer automatically exclude patients from endovascular therapy, but future studies must refine imaging selection and collateral assessment.<br /><br />Dr. Vivek Yeravalli then discussed medium vessel occlusions (MeVOs), which are common but technically and diagnostically challenging. He reviewed three recent randomized trials—DISTAL, DISCOUNT, and ESCAPE-MeVO—which were negative for added benefit of thrombectomy over best medical management. He highlighted limitations of noncontrast CT and CTA alone, and argued that CT perfusion can improve detection, prognostication, and collateral evaluation. The session concluded with practical discussion of CTA/CTP workflows, AI tools, and the growing role of imaging in selecting stroke patients for therapy.

Keywords

acute ischemic stroke

thrombectomy

neuroimaging

large core stroke

ASPECTS

CT perfusion

medium vessel occlusion

CTA workflow

collateral assessment