A recent study out of China investigated the efficacy of endovascular therapy in patients with acute ischemic stroke with a large infarct core. The prospective, open-label ANGEL-ASPECT trial enrolled 456 patients with acute large-vessel occlusion in the anterior circulation and an Alberta Stroke Program Early Computed Tomography Score of 3-5 or an infarct-core volume of 70-100 ml. Participants were randomly assigned to receive endovascular therapy plus medical management (N=231) or medical management alone (N=225) within 24 hours of the time they were last known to be well. I.V. thrombolysis was administered in about 28% of cases. The efficacy of endovascular therapy prompted the trial to stop early, after the second interim analysis. The researchers noted the distribution of scores on the modified Rankin scale had shifted — the primary objective — toward improved outcomes in favor of endovascular therapy vs. medical management only (generalized odds ratio, 1.37; 95% confidence interval, 1.11 to 1.69; P=0.004). However, 6.1% (14/230) of patients in the endovascular therapy group and 2.7% (6/225) patients in the medical-management group were diagnosed with symptomatic intracranial hemorrhage, while any intracranial hemorrhage occurred in 49.1% (113) and 17.3% (39), respectively. In general, the findings for the secondary outcomes — scores of 0-2 and 0-3 on the modified Rankin scale — backed those found in the primary analysis.