Endovascular Thrombectomy for Large Ischemic Stroke Across Ischemic Injury and Penumbra Profiles
Published on: March 26, 2024
An exploratory analysis of SELECT2, a randomized clinical trial of patients with acute ischemic stroke and large cores, shows that endovascular thrombectomy (EVT) boosted clinical outcomes compared with medical management (MM). The study included 336 patients with acute ischemic stroke due to occlusion of the internal carotid or middle cerebral artery (M1 segment) and large ischemic core who were randomized to EVT or medical management. At 90 days, functional outcomes with EVT improved compared with MM in an ordinal analysis of the modified Rankin Scale (mRS) score within Alberta Stroke Program Early 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 compared with MM were 1.63 for volumes ≥70 mL, 1.41 for ≥100 mL, and 1.47 for ≥150 mL across strata for CT perfusion/MRO ischemic core volumes. Outcomes worsened as ASPECTS decreased and as CT perfusion/MRI ischemic core volume rose in the EVT group. “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 researchers conclude.