Thrombectomy for large core: how can we explain the strong clinical benefit?

In this compelling lecture, Tudor Jovin addresses the paradox of strong clinical benefits from thrombectomy in large core infarcts. Drawing on recent trial data and guideline updates, he argues that infarct size in the early time window is a prognostic factor, not a treatment effect modifier. He explores several explanations for the observed benefit, including discrepancies between imaging and true infarct core, reperfusion effects beyond penumbral salvage, edema reduction, and potential neuroprotection.