Patients With Low NWU Have Greater Functional Benefit From EVT vs BMT Alone

Background: Recent randomized trials have shown that adding endovascular thrombectomy (EVT) to best medical therapy (BMT) improves outcomes in patients with large ischemic strokes. Despite these gains, many individuals with extensive early infarcts continue to have poor recovery, raising the question of how to better identify those likely to benefit. Functional CT-based ASPECTS (Alberta Stroke Program Early CT Score) scoring—a visual estimate of infarct size—does not fully capture the physiologic state of the injured tissue. Net water uptake (NWU), a quantitative CT densitometry marker that reflects early ischemic edema, may provide additional prognostic value. Prior observational studies have linked higher NWU to worse functional outcomes after EVT, but randomized trial–level data have not evaluated whether NWU can refine patient selection. This study used data from the large multicenter TENSION trial to examine whether the degree of hypoattenuation on admission no more...