Amukotuwa SA, et al. - Since accurate and rapid identification of anterior circulation large vessel occlusion (LVO) is of paramount importance in acute stroke patients due to the potentially rapid infarction of at-risk tissue and the limited therapeutic window for endovascular clot retrieval, researchers conducted this large cohort study to determine the optimal threshold of a new, fully automated software-based approach for LVO detection and assess its diagnostic performance. They pooled data from: two stroke trials, DEFUSE 2 (n = 62; 07/08–09/11) and DEFUSE 3 (n = 213; 05/17–05/18); a cohort of endovascular clot retrieval candidates (n = 82; August 2, 2014–August 30, 2015) and normals (n = 111; June 6, 2017–January 28, 2019) from a single quaternary center; and code stroke patients (n = 501; January 1, 2017–December 31, 2018) from a single regional hospital. CTAs from 926 individuals (median age 70 years, interquartile range: 58-80) were analyzed in this retrospective study. Data reported that sensitivity and specificity were 97% and 74%, respectively, for LVO detection, and 95% and 79%, respectively, when M2 occlusions were involved. Sensitivities were 90% (M2-MCA), 97% (M1-MCA), and 97% (intracranial internal carotid artery) with corresponding area-under-the-ROC-curves of 0.874 (M2), 0.962 (M1), and 0.997 (intracranial internal carotid artery) on analysis by occlusion site. Findings suggest that an automated detection system can quickly and reliably detect intracranial anterior circulation LVOs and proximal M2 occlusions, which can promote intra- and inter-instutional workflows and evolving imaging triage in the treatment of stroke patients.