Stroke in patients with Very large Ischaemic Core: Assessment of Reperfusion therapy Impact on Outcome (SICARIO-VLC)

SICARIO-VLC is a clinical trial for people who have had a large ischaemic stroke — where a blood clot blocks an artery and causes a significant area of brain tissue to be at risk. When the affected area of the brain is very large (over 100 mL), doctors have traditionally been reluctant to attempt clot removal (thrombectomy), fearing the risks might outweigh the benefits. This trial challenges that assumption. Participants are randomly assigned to receive either standard medical care or endovascular thrombectomy — a procedure where a catheter is guided through a blood vessel to physically remove the clot from the brain. The primary question is whether thrombectomy prevents the worst outcomes (such as death or severe disability) in patients with very large stroke cores. You may be eligible if you are 18 or older, have had a large vessel occlusion stroke within the last 24 hours, have a very large ischaemic core on imaging (over 100 mL), and were previously functioning well (minimal disability). People with brain bleeding, severe pre-existing disability, vertebral or basilar artery occlusions, or a terminal illness are not eligible. Time is critical — the procedure must be started within two hours of brain imaging.