RAPID–LC: rapid evidence-to-practice uptake of large core thrombectomy across a stroke consortium

Osman Mir; Alzahra’a Al Matairi; Dan Nguyen; Amrou Sarraj; Adam A. Dmytriw; Adnan H. Siddiqui; Ramesh Grandhi; Jaydevsinh N. Dolia; Diogo C. Haussen; Alhamza R. Al-Bayati; Raul G. Nogueira; Brendan Eby; Ali Alaraj; Saif Bushnaq; Jan Karl Burkhardt; Visish Srinivasan; Hesham Masoud; Navdeep Sangha; Angus Lee; Yazan Ashouri; Imran Farooqui; Yazan J. Alderazi; Gerald Ogola; Kartik Akkihal; Abdelrahaman Beltagy; Kelsey R. Duncan; Yan Lin Li; Lukasz Przepiorka; Omid Shoraka; Theja Yelam; Mohamed F. Doheim; Laura Heitsch; Tatiana Abou-Mrad; Pichatorn Suppakitjanusant; Kyle Scott; Momotaz Begum; Mohammand AlMajali; Faisal Al-Shaibi; Zheqing Zhang; Prince Pekyi-Boateng; Mithilesh Siddu; Mohammad Khasawneh; Michael Adegoke; Myriam Vijil; Habib Akouri; Zuhair Ali; Osama Zaidat; Mohamad Ezzeldin

doi:10.1007/s00415-026-13866-2

RAPID–LC: rapid evidence-to-practice uptake of large core thrombectomy across a stroke consortium

Osman Mir
, Alzahra’a Al Matairi
, Dan Nguyen
, Amrou Sarraj
, Adam A. Dmytriw
, Adnan H. Siddiqui
, Ramesh Grandhi
, Jaydevsinh N. Dolia
, Diogo C. Haussen
, Alhamza R. Al-Bayati
, Raul G. Nogueira
, Brendan Eby
, Ali Alaraj
, Saif Bushnaq
, Jan Karl Burkhardt
, Visish Srinivasan
, Hesham Masoud
, Navdeep Sangha
, Angus Lee
, Yazan Ashouri

Imran Farooqui, Yazan J. Alderazi, Gerald Ogola, Kartik Akkihal, Abdelrahaman Beltagy, Kelsey R. Duncan, Yan Lin Li, Lukasz Przepiorka, Omid Shoraka, Theja Yelam, Mohamed F. Doheim, Laura Heitsch, Tatiana Abou-Mrad, Pichatorn Suppakitjanusant, Kyle Scott, Momotaz Begum, Mohammand AlMajali, Faisal Al-Shaibi, Zheqing Zhang, Prince Pekyi-Boateng, Mithilesh Siddu, Mohammad Khasawneh, Michael Adegoke, Myriam Vijil, Habib Akouri, Zuhair Ali, Osama Zaidat, Mohamad Ezzeldin

Neurosurgery

Baylor Health Care System
University of Jordan
Texas Stroke Institute
Case Western Reserve University
Oxford University Hospitals NHS Foundation Trust
University of Utah
Emory University
Grady Health System
University of Pittsburgh
Washington University St. Louis
University of Illinois at Chicago
Texas Tech University Health Sciences Center
University of Pennsylvania
SUNY Upstate Medical University
Kaiser Permanente
St. Vincent Medical Center
HCA
Texas A&M University
SUNY Buffalo
University of Oxford
University of Houston

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Recent landmark trials, including SELECT2, ANGEL-ASPECT, and RESCUE-Japan LIMIT, demonstrated the benefit of endovascular thrombectomy (EVT) in patients with large ischemic cores, primarily among those with ASPECTS 3–5, with limited representation of ASPECTS 0–2. However, real-world adoption across the full spectrum of low ASPECTS remains uncertain. Methods: We conducted a retrospective, multicenter, before–and–after cohort study comparing the pre-publication (July–December 2021, n = 150) and post-publication (January–June 2024, n = 195) periods. Adults presenting within 24 h of large vessel occlusion stroke with large cores (ASPECTS ≤ 5 or CT core > 70 mL) were included. The primary outcome was EVT utilization (receipt of thrombectomy). Secondary outcomes were 30- and 90-day modified Rankin Scale (mRS) and mortality. Safety outcomes included symptomatic intracranial hemorrhage and procedural complications. Multivariable logistic regression identified independent predictors of receiving EVT, adjusting for clinical and imaging variables. Results: A total of 345 patients were included (median age 70 years, 52% male). EVT utilization increased from 42% (63/150) in 2021 to 60.5% (118/195) in 2024. In multivariable analysis, the year 2024 was the strongest independent predictor of receiving EVT (adjusted OR 3.11; p < 0.001). ASPECTS score was the dominant imaging predictor of receiving EVT (adjusted OR 7.11 for ASPECTS 3–5 vs 0–2). EVT use in patients with ASPECTS 0–2 increased from 4.3 to 32.5%. Among treated cohorts, mortality increased non-significantly from 27 to 33.9% (p = 0.340). Functional outcomes at 30 and 90 days did not differ significantly between cohorts. Conclusion: Publication of large core thrombectomy trials was associated with substantial increases in endovascular thrombectomy use in large-core stroke, including among patients with very low ASPECTS, with a non-significant increase in symptomatic intracranial hemorrhage and a decline in favorable functional outcomes. Clinician adherence to baseline severity considerations (ASPECTS, age, and premorbid function) appears appropriate. These findings demonstrate the safe and rapid translation of evidence into practice and highlight the importance of standardized implementation strategies to optimize patient outcomes.

Original language	English
Article number	343
Journal	Journal of Neurology
Volume	273
Issue number	6
DOIs	https://doi.org/10.1007/s00415-026-13866-2
State	Published - Jun 2026

Keywords

ASPECTS score
Endovascular thrombectomy
Implementation
Large core infarction
Outcomes
Practice patterns

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10.1007/s00415-026-13866-2

Cite this

Mir, O., Al Matairi, A., Nguyen, D., Sarraj, A., Dmytriw, A. A., Siddiqui, A. H., Grandhi, R., Dolia, J. N., Haussen, D. C., Al-Bayati, A. R., Nogueira, R. G., Eby, B., Alaraj, A., Bushnaq, S., Burkhardt, J. K., Srinivasan, V., Masoud, H., Sangha, N., Lee, A., ... Ezzeldin, M. (2026). RAPID–LC: rapid evidence-to-practice uptake of large core thrombectomy across a stroke consortium. Journal of Neurology, 273(6), Article 343. https://doi.org/10.1007/s00415-026-13866-2

@article{595bddea6f704212bde52f9baf98729b,

title = "RAPID{\textendash}LC: rapid evidence-to-practice uptake of large core thrombectomy across a stroke consortium",

abstract = "Background: Recent landmark trials, including SELECT2, ANGEL-ASPECT, and RESCUE-Japan LIMIT, demonstrated the benefit of endovascular thrombectomy (EVT) in patients with large ischemic cores, primarily among those with ASPECTS 3{\textendash}5, with limited representation of ASPECTS 0{\textendash}2. However, real-world adoption across the full spectrum of low ASPECTS remains uncertain. Methods: We conducted a retrospective, multicenter, before{\textendash}and{\textendash}after cohort study comparing the pre-publication (July{\textendash}December 2021, n = 150) and post-publication (January{\textendash}June 2024, n = 195) periods. Adults presenting within 24 h of large vessel occlusion stroke with large cores (ASPECTS ≤ 5 or CT core > 70 mL) were included. The primary outcome was EVT utilization (receipt of thrombectomy). Secondary outcomes were 30- and 90-day modified Rankin Scale (mRS) and mortality. Safety outcomes included symptomatic intracranial hemorrhage and procedural complications. Multivariable logistic regression identified independent predictors of receiving EVT, adjusting for clinical and imaging variables. Results: A total of 345 patients were included (median age 70 years, 52\% male). EVT utilization increased from 42\% (63/150) in 2021 to 60.5\% (118/195) in 2024. In multivariable analysis, the year 2024 was the strongest independent predictor of receiving EVT (adjusted OR 3.11; p < 0.001). ASPECTS score was the dominant imaging predictor of receiving EVT (adjusted OR 7.11 for ASPECTS 3{\textendash}5 vs 0{\textendash}2). EVT use in patients with ASPECTS 0{\textendash}2 increased from 4.3 to 32.5\%. Among treated cohorts, mortality increased non-significantly from 27 to 33.9\% (p = 0.340). Functional outcomes at 30 and 90 days did not differ significantly between cohorts. Conclusion: Publication of large core thrombectomy trials was associated with substantial increases in endovascular thrombectomy use in large-core stroke, including among patients with very low ASPECTS, with a non-significant increase in symptomatic intracranial hemorrhage and a decline in favorable functional outcomes. Clinician adherence to baseline severity considerations (ASPECTS, age, and premorbid function) appears appropriate. These findings demonstrate the safe and rapid translation of evidence into practice and highlight the importance of standardized implementation strategies to optimize patient outcomes.",

keywords = "ASPECTS score, Endovascular thrombectomy, Implementation, Large core infarction, Outcomes, Practice patterns",

author = "Osman Mir and \{Al Matairi\}, Alzahra{\textquoteright}a and Dan Nguyen and Amrou Sarraj and Dmytriw, \{Adam A.\} and Siddiqui, \{Adnan H.\} and Ramesh Grandhi and Dolia, \{Jaydevsinh N.\} and Haussen, \{Diogo C.\} and Al-Bayati, \{Alhamza R.\} and Nogueira, \{Raul G.\} and Brendan Eby and Ali Alaraj and Saif Bushnaq and Burkhardt, \{Jan Karl\} and Visish Srinivasan and Hesham Masoud and Navdeep Sangha and Angus Lee and Yazan Ashouri and Imran Farooqui and Alderazi, \{Yazan J.\} and Gerald Ogola and Kartik Akkihal and Abdelrahaman Beltagy and Duncan, \{Kelsey R.\} and Li, \{Yan Lin\} and Lukasz Przepiorka and Omid Shoraka and Theja Yelam and Doheim, \{Mohamed F.\} and Laura Heitsch and Tatiana Abou-Mrad and Pichatorn Suppakitjanusant and Kyle Scott and Momotaz Begum and Mohammand AlMajali and Faisal Al-Shaibi and Zheqing Zhang and Prince Pekyi-Boateng and Mithilesh Siddu and Mohammad Khasawneh and Michael Adegoke and Myriam Vijil and Habib Akouri and Zuhair Ali and Osama Zaidat and Mohamad Ezzeldin",

note = "Publisher Copyright: {\textcopyright} Springer-Verlag GmbH Germany, part of Springer Nature 2026.",

year = "2026",

month = jun,

doi = "10.1007/s00415-026-13866-2",

language = "English",

volume = "273",

journal = "Journal of Neurology",

issn = "0340-5354",

publisher = "Springer Science and Business Media Deutschland GmbH",

number = "6",

}

Mir, O, Al Matairi, A, Nguyen, D, Sarraj, A, Dmytriw, AA, Siddiqui, AH, Grandhi, R, Dolia, JN, Haussen, DC, Al-Bayati, AR, Nogueira, RG, Eby, B, Alaraj, A, Bushnaq, S, Burkhardt, JK, Srinivasan, V, Masoud, H, Sangha, N, Lee, A, Ashouri, Y, Farooqui, I, Alderazi, YJ, Ogola, G, Akkihal, K, Beltagy, A, Duncan, KR, Li, YL, Przepiorka, L, Shoraka, O, Yelam, T, Doheim, MF, Heitsch, L, Abou-Mrad, T, Suppakitjanusant, P, Scott, K, Begum, M, AlMajali, M, Al-Shaibi, F, Zhang, Z, Pekyi-Boateng, P, Siddu, M, Khasawneh, M, Adegoke, M, Vijil, M, Akouri, H, Ali, Z, Zaidat, O & Ezzeldin, M 2026, 'RAPID–LC: rapid evidence-to-practice uptake of large core thrombectomy across a stroke consortium', Journal of Neurology, vol. 273, no. 6, 343. https://doi.org/10.1007/s00415-026-13866-2

TY - JOUR

T1 - RAPID–LC

T2 - rapid evidence-to-practice uptake of large core thrombectomy across a stroke consortium

AU - Mir, Osman

AU - Al Matairi, Alzahra’a

AU - Nguyen, Dan

AU - Sarraj, Amrou

AU - Dmytriw, Adam A.

AU - Siddiqui, Adnan H.

AU - Grandhi, Ramesh

AU - Dolia, Jaydevsinh N.

AU - Haussen, Diogo C.

AU - Al-Bayati, Alhamza R.

AU - Nogueira, Raul G.

AU - Eby, Brendan

AU - Alaraj, Ali

AU - Bushnaq, Saif

AU - Burkhardt, Jan Karl

AU - Srinivasan, Visish

AU - Masoud, Hesham

AU - Sangha, Navdeep

AU - Lee, Angus

AU - Ashouri, Yazan

AU - Farooqui, Imran

AU - Alderazi, Yazan J.

AU - Ogola, Gerald

AU - Akkihal, Kartik

AU - Beltagy, Abdelrahaman

AU - Duncan, Kelsey R.

AU - Li, Yan Lin

AU - Przepiorka, Lukasz

AU - Shoraka, Omid

AU - Yelam, Theja

AU - Doheim, Mohamed F.

AU - Heitsch, Laura

AU - Abou-Mrad, Tatiana

AU - Suppakitjanusant, Pichatorn

AU - Scott, Kyle

AU - Begum, Momotaz

AU - AlMajali, Mohammand

AU - Al-Shaibi, Faisal

AU - Zhang, Zheqing

AU - Pekyi-Boateng, Prince

AU - Siddu, Mithilesh

AU - Khasawneh, Mohammad

AU - Adegoke, Michael

AU - Vijil, Myriam

AU - Akouri, Habib

AU - Ali, Zuhair

AU - Zaidat, Osama

AU - Ezzeldin, Mohamad

PY - 2026/6

Y1 - 2026/6

N2 - Background: Recent landmark trials, including SELECT2, ANGEL-ASPECT, and RESCUE-Japan LIMIT, demonstrated the benefit of endovascular thrombectomy (EVT) in patients with large ischemic cores, primarily among those with ASPECTS 3–5, with limited representation of ASPECTS 0–2. However, real-world adoption across the full spectrum of low ASPECTS remains uncertain. Methods: We conducted a retrospective, multicenter, before–and–after cohort study comparing the pre-publication (July–December 2021, n = 150) and post-publication (January–June 2024, n = 195) periods. Adults presenting within 24 h of large vessel occlusion stroke with large cores (ASPECTS ≤ 5 or CT core > 70 mL) were included. The primary outcome was EVT utilization (receipt of thrombectomy). Secondary outcomes were 30- and 90-day modified Rankin Scale (mRS) and mortality. Safety outcomes included symptomatic intracranial hemorrhage and procedural complications. Multivariable logistic regression identified independent predictors of receiving EVT, adjusting for clinical and imaging variables. Results: A total of 345 patients were included (median age 70 years, 52% male). EVT utilization increased from 42% (63/150) in 2021 to 60.5% (118/195) in 2024. In multivariable analysis, the year 2024 was the strongest independent predictor of receiving EVT (adjusted OR 3.11; p < 0.001). ASPECTS score was the dominant imaging predictor of receiving EVT (adjusted OR 7.11 for ASPECTS 3–5 vs 0–2). EVT use in patients with ASPECTS 0–2 increased from 4.3 to 32.5%. Among treated cohorts, mortality increased non-significantly from 27 to 33.9% (p = 0.340). Functional outcomes at 30 and 90 days did not differ significantly between cohorts. Conclusion: Publication of large core thrombectomy trials was associated with substantial increases in endovascular thrombectomy use in large-core stroke, including among patients with very low ASPECTS, with a non-significant increase in symptomatic intracranial hemorrhage and a decline in favorable functional outcomes. Clinician adherence to baseline severity considerations (ASPECTS, age, and premorbid function) appears appropriate. These findings demonstrate the safe and rapid translation of evidence into practice and highlight the importance of standardized implementation strategies to optimize patient outcomes.

AB - Background: Recent landmark trials, including SELECT2, ANGEL-ASPECT, and RESCUE-Japan LIMIT, demonstrated the benefit of endovascular thrombectomy (EVT) in patients with large ischemic cores, primarily among those with ASPECTS 3–5, with limited representation of ASPECTS 0–2. However, real-world adoption across the full spectrum of low ASPECTS remains uncertain. Methods: We conducted a retrospective, multicenter, before–and–after cohort study comparing the pre-publication (July–December 2021, n = 150) and post-publication (January–June 2024, n = 195) periods. Adults presenting within 24 h of large vessel occlusion stroke with large cores (ASPECTS ≤ 5 or CT core > 70 mL) were included. The primary outcome was EVT utilization (receipt of thrombectomy). Secondary outcomes were 30- and 90-day modified Rankin Scale (mRS) and mortality. Safety outcomes included symptomatic intracranial hemorrhage and procedural complications. Multivariable logistic regression identified independent predictors of receiving EVT, adjusting for clinical and imaging variables. Results: A total of 345 patients were included (median age 70 years, 52% male). EVT utilization increased from 42% (63/150) in 2021 to 60.5% (118/195) in 2024. In multivariable analysis, the year 2024 was the strongest independent predictor of receiving EVT (adjusted OR 3.11; p < 0.001). ASPECTS score was the dominant imaging predictor of receiving EVT (adjusted OR 7.11 for ASPECTS 3–5 vs 0–2). EVT use in patients with ASPECTS 0–2 increased from 4.3 to 32.5%. Among treated cohorts, mortality increased non-significantly from 27 to 33.9% (p = 0.340). Functional outcomes at 30 and 90 days did not differ significantly between cohorts. Conclusion: Publication of large core thrombectomy trials was associated with substantial increases in endovascular thrombectomy use in large-core stroke, including among patients with very low ASPECTS, with a non-significant increase in symptomatic intracranial hemorrhage and a decline in favorable functional outcomes. Clinician adherence to baseline severity considerations (ASPECTS, age, and premorbid function) appears appropriate. These findings demonstrate the safe and rapid translation of evidence into practice and highlight the importance of standardized implementation strategies to optimize patient outcomes.

KW - ASPECTS score

KW - Endovascular thrombectomy

KW - Implementation

KW - Large core infarction

KW - Outcomes

KW - Practice patterns

UR - https://www.scopus.com/pages/publications/105040415839

U2 - 10.1007/s00415-026-13866-2

DO - 10.1007/s00415-026-13866-2

M3 - Article

C2 - 42189238

AN - SCOPUS:105040415839

SN - 0340-5354

VL - 273

JO - Journal of Neurology

JF - Journal of Neurology

IS - 6

M1 - 343

ER -

RAPID–LC: rapid evidence-to-practice uptake of large core thrombectomy across a stroke consortium

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