Peer-Reviewed Publication
Stroke2026July 6, 2026Journal Article
Defining the Therapeutic Ceiling of Endovascular Thrombectomy in Large-Core Stroke: Beyond the Limits of ASPECTS.
Hokyu Kim1, Wi-Sun Ryu2, Manabu Inoue3, Leonard Sunwoo4, Kyusik Kang5, Jae Guk Kim6, Soo Joo Lee6, Jae-Kwan Cha7, Tai Hwan Park8, Jeong-Yoon Lee9, Kyungbok Lee9, Doo Hyuk Kwon10, Jun Lee10, Hong-Kyun Park11, Keun-Sik Hong11, Minwoo Lee12, Mi Sun Oh12, Kyung-Ho Yu12, Dong-Seok Gwak13, Dong-Eog Kim13, Hyunsoo Kim14, Joon-Tae Kim14, Joong-Goo Kim15, Jay Chol Choi15, Wook-Joo Kim16, Jee Hyun Kwon16, Kyu Sun Yum17, Dong-Ick Shin17, Jeong-Ho Hong18, Sung-Il Sohn18, Sang-Hwa Lee19, Chulho Kim19, Hae-Bong Jeong20, Kwang-Yeol Park20, Keon-Joo Lee1, Chi Kyung Kim1, Jihoon Kang21, Jun Yup Kim21, Hee-Joon Bae21, Beom-Joon Kim21
1Department of Neurology, Korea University Guro Hospital, Seoul (Hokyu Kim, K.-J.L., C.K.K.).
2Artificial Intelligence Research Center, JLK Inc, Seoul, Korea (W.-S.R.).
3Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (M.I.).
4Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. (L.S.).
5Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea (K.K.).
6Department of Neurology, Eulji University School of Medicine, Daejeon Eulji Medical Center, Korea (J.G.K., S.J.L.).
7Department of Neurology, Dong-A University Hospital, Busan, Korea (J.-K.C.).
8Department of Neurology, Seoul Medical Center, Korea (T.H.P.).
9Department of Neurology, Soonchunhyang University Seoul Hospital, Korea (J.-Y.L., K.L.).
10Department of Neurology, Yeungnam University Medical Center, Daegu, Korea (D.H.K., J.L.).
11Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea (H.-K.P., K.-S.H.).
12Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea (M.L., M.S.O., K.-H.Y.).
13Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea (D.-S.G., D.-E.K.).
14Department of Neurology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea (Hyunsoo Kim, J.-T.K.).
15Department of Neurology, Jeju National University Hospital, Korea (J.-G.K., J.C.C.).
16Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Korea (W.-J.K., J.H.K.).
17Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea (K.S.Y., D.-I.S.).
18Department of Neurology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea (J.-H.H., S.-I.S.).
19Department of Neurology, Hallym University Chuncheon Sacred Heart Hospital, Korea (S.-H.L., C.K.).
20Department of Neurology, Chung-Ang University Hospital, Seoul, Korea (H.B.J., K.-Y.P.).
21Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. (J.K., J.Y.K., H.-J.B., B.-J.K.).
Abstract
BACKGROUND: Recent trials established the efficacy of thrombectomy for large-core stroke by utilizing the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) as a pragmatic tool. However, whether this topographical scoring captures the therapeutic ceiling, or the upper threshold of infarct volume where the benefit of reperfusion diminishes, remains unclear.
METHODS: Leveraging a nati…
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