Trial of Endovascular Thrombectomy for Large Ischemic Strokes
Published on: April 24, 2023
Endovascular thrombectomy plus standard medical care led to better outcomes than standard medical care alone for patients with large ischemic strokes, researchers for the SELECT2 trial report. The prospective, international trial evaluated endovascular thrombectomy within 24 hours after onset in patients with stroke due to occlusion of the internal carotid artery or the first segment of the middle cerebral artery. The study was conducted at 31 sites in the United States, Canada, Europe, Australia, and New Zealand. Patients — who had a large ischemic-core volume (an Alberta Stroke Program Early Computer Tomography Score of 3-5) — were randomized 1:1 to endovascular thrombectomy and standard medical care or to medical care only. The trial was stopped early due to efficacy, with 178 patients in the thrombectomy group and 174 in the medical care group. At 90 days, the median score on the modified Rankin scale — the primary outcome — was 4, while the generalized odds ratio favoring endovascular thrombectomy was 1.51. Functional independence — a secondary outcome — was reported in 20% of the thrombectomy group and 7% of the medical care group at 90 days. One patient in the thrombectomy group and 2 in the medical care group experienced symptomatic intracranial hemorrhage. Thirty-three patients (18.5%) in the thrombectomy group had procedural complications: five had arterial access-site complications, 10 had vascular dissections, 7 had arterial perforation, and 11 had intraprocedural vasospasm.