Endovascular thrombectomy found to be beneficial for large ischemic stroke

For patients with acute ischemic stroke and large cores, endovascular thrombectomy (EVT) improves clinical outcomes compared with medical management (MM), according to a study published online Feb. 7 in the Journal of the American Medical Association to coincide with the annual American Stroke Association International Stroke Conference, which was held from Feb. 7 to 9 in Phoenix.

Amrou Sarraj, M.D., from Case Western Reserve University in Cleveland, and colleagues describe the relationship between imaging estimates of irreversibly injured brain and at-risk regions and clinical outcomes and EVT treatment effect in an exploratory analysis of the SELECT2 trial.

Adults with acute ischemic stroke due to occlusion of the internal carotid or middle cerebral artery (M1 segment) and large ischemic core were randomly allocated to EVT versus MM across 31 global centers; the analysis included 336 patients.

The researchers found that EVT improved functional outcomes compared with MM in an ordinal analysis of the modified Rankin Scale (mRS) at 90 days within Alberta Stroke Program Early Computed Tomography (CT) Score (ASPECTS) categories of 3, 4, and 5 (adjusted generalized odds ratios [aGenORs], 1.71, 2.01, and 1.85, respectively).

The aGenORs for EVT versus MM were 1.63, 1.41, and 1.47, respectively, for ≥70, ≥100, and ≥150 mL across strata for CT perfusion/magnetic resonance imaging (MRI) ischemic core volumes. Outcomes worsened as ASPECTS decreased and as CT perfusion/MRI ischemic volume increased in the EVT group (aGenOR, 0.92 per 10-mL increase).

"EVT improved functional outcomes in ordinal analysis of the mRS score across a wide spectrum of ischemic injury extent when compared with medical management only," the authors write.

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