Quantitative Volumetry Defines 110 mL Infarct Threshold Beyond Which Thrombectomy Benefit Is Lost

Retrospective analysis of 552 patients: quantitative infarct volumetry placed the thrombectomy benefit ceiling at 110 mL. Benefit at 50–110 mL (cOR 0.38, 95% CI 0.15–0.97), lost >110 mL. ASPECTS misclassified 'large core'—these patients had poor outcome 11.8% vs small-core 11.7%.

• Design: Retrospective target trial emulation using a nationwide Korean registry (2022–2024), 552 thrombectomy-treated patients; mean age 70 years, 57.8% men.
• Volumetric large core by DWI, CTP, and NCCT consistently predicted poor 90-day outcome (adjusted OR 6.92 [95% CI, 2.58–19.34] for DWI-only large core), regardless of ASPECTS.
• Limitation: Single-country retrospective data, target trial emulation assumes no unmeasured confounding; results require external validation before changing clinical practice.

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