Importance, Objective, and Methods: This randomized trial assessed the effectiveness of thrombectomy in patients with large infarcts on noncontrast CT within 24 hours of stroke onset. The trial enrolled 300 patients with anterior-circulation, large-vessel occlusion, and Alberta Stroke Program Early CT Scores of 2 to 5 at 47 stroke centers.

Intervention: Patients in the intervention group (n=152) received endovascular thrombectomy and medical care, while the control group (n=148) received only medical care.

Main Outcomes: The primary endpoint was improvement in 90-day functional outcomes (measured with the UW-mRS scale). Secondary endpoints included 90-day mortality, symptomatic intracranial hemorrhage, and radiographic hemorrhage.

Results: The mean 90-day UW-mRS score was 2.93 for the thrombectomy group vs. 2.27 for the control group (adjusted difference: 0.63). Mortality was similar in both groups (35.3% vs. 33.3%). Thrombectomy was associated with higher rates of intracranial hemorrhage, including symptomatic and parenchymal hemorrhages.

Conclusions: Thrombectomy did not show significant improvements in functional outcomes for patients with large infarcts on noncontrast CT. Further studies are needed to explore the potential role of thrombectomy in this patient group.