Analysis of 403 large-core stroke patients across 41 international centers found that sophisticated imaging techniques like CT perfusion and diffusion-weighted MRI offered no clinical advantage over standard non-contrast CT for selecting thrombectomy candidates. All three imaging approaches yielded similar rates of favorable 90-day outcomes (mRS 0-3), successful vessel reopening, and bleeding complications, despite diffusion-weighted imaging achieving slightly higher complete recanalization rates (50.9% vs 41.3% for CT alone). This challenges the widespread assumption that advanced neuroimaging improves patient selection for emergency stroke intervention. The finding has significant implications for stroke care accessibility, particularly in resource-limited settings where CT perfusion and MRI may be unavailable during critical treatment windows. While advanced imaging provides detailed tissue viability information, this real-world evidence suggests standard CT's simplicity and speed may be sufficient for identifying appropriate thrombectomy candidates with large infarct cores. The research supports streamlined stroke protocols that could reduce door-to-needle times and expand treatment access globally. However, the study's observational design cannot definitively establish equivalence, and selection bias may influence which patients receive different imaging modalities. These results warrant prospective validation in randomized trials before fundamentally altering stroke imaging protocols.