Patients with large-core ischaemic stroke face a difficult choice between surgery and medical care. A new analysis of data from 1,886 patients helps clarify this decision for those who arrive within 24 hours of their stroke starting. The study focused on people with significant brain damage, defined by a score of 5 or less on the Alberta Stroke Program Early CT Score or an estimated damaged area of 50 milliliters or more.
The team found that the surgery group had better function at 90 days compared to those receiving only medical management. Death rates were also lower in the surgery group. These benefits held true across different levels of brain damage and time since stroke onset, as long as the damage was not extremely widespread.
Safety checks showed no significant difference in bleeding risks between the two groups. However, the study notes that results for patients with very large damaged areas of 150 milliliters or more are less certain. This analysis confirms that surgery helps many patients but highlights where the evidence remains thin.