Large Infarct Stroke: Endovascular Thrombectomy Shows Promise

Endovascular thrombectomy significantly improves functional outcomes and reduces mortality in acute ischemic stroke patients with large infarcts, even when using non-contrast CT for patient selection, a recent study published in The Lancet has shown.

In this trial, patients with acute ischemic stroke caused by large vessel occlusion in the anterior circulation, along with a large established infarct indicated by a specific score (ASPECTS 3-5), were enrolled. The study, conducted in 40 hospitals in Europe and one site in Canada, used a central web-based system to randomly assign patients to receive either endovascular thrombectomy in addition to medical treatment or medical treatment alone, within 12 hours from the onset of the stroke.

Between July 17, 2018, and February 21, 2023, a total of 253 patients were randomly assigned, with 125 receiving endovascular thrombectomy and 128 receiving medical treatment alone. Astonishingly, the trial was halted early due to the treatment's remarkable efficacy, as indicated by the results of the first pre-planned interim analysis.

At the 90-day mark, the endovascular thrombectomy group showed a significant improvement in the distribution of scores on the modified Rankin Scale, pointing towards better outcomes. Moreover, the thrombectomy group had a lower mortality rate. Symptomatic intracranial hemorrhage, a critical safety concern, occurred in a limited number of cases, with 6% of patients in the thrombectomy group and 5% in the medical treatment group experiencing this complication.

Ref:Endovascular thrombectomy for acute ischaemic stroke with established large infarct: multicentre, open-label, randomised trial, Prof Martin Bendszus, et al.October 11, 2023, DOI:https://doi.org/10.1016/S0140-6736(23)02032-9