Episode 313: 312. Trial of Thrombectomy for Stroke with a Large Infarct of Unrestricted Size

https://www.nejm.org/doi/10.1056/NEJMoa2314063

Randomized trials have shown the benefit of endovascular thrombectomy in patients with acute stroke due to large-artery occlusion in the anterior circulation and a large baseline infarct (core) In these trials,1-5 a large core was defined by an ASPECTS value of 5 or less, but because of concerns about the deleterious effects associated with the reperfusion of large infarcts,8 patients with the largest infarcts (ASPECTS value, 0 or 1) were excluded from enrollment

Now, researchers have compared EVT plus medical therapy to medical therapy alone in patients who could be treated within 6.5 hours of stroke onset and had a large amount of ischemic tissue

The primary outcome was the modified Rankin scale (mRS) score and the major safety outcome was all-cause mortality, both at 90 days.

a 3-year period, 333 patients cerebral vessel occlusion in the anterior circulation

The median NIH Stroke Scale score was 21, and the median baseline infarct volume was 135 mL;

Median time to randomization was 270 minutes after symptom onset. The EVT group had a lower median mRS score at 90 days than the medical-therapy group (4 vs. 6) and also lower mortality (36% vs. 56%).

The overall rate of death or dependency (mRS score ≥4) at 90 days was high in both groups but lower with thrombectomy (67% vs. 88%). NNT of 5

Symptomatic intracranial hemorrhage was more common with EVT (9.6% vs. 5.7%).—NNH of 25