A new American Heart Association science advisory analyzing 6 randomized clinical trials finds endovascular thrombectomy significantly improves outcomes in select patients with large-core ischemic stroke.
The analysis, encompassing 1,887 patients, found endovascular thrombectomy (EVT) increased functional independence rates to 19.5% compared with 7.5% for medical management alone, with a number needed to treat of 8. The combined analysis showed an odds ratio of 1.57 (95% CI, 1.40-1.76) favoring EVT.
Large-core ischemic stroke (LCIS), defined as irreversibly injured cerebral tissue, represents approximately 25% of ischemic strokes attributable to large vessel occlusion among patients presenting within 8 hours to referral centers. Historically, these patients were often excluded from EVT trials due to concerns about limited benefit.
The advisory examined trials using various imaging criteria, including Alberta Stroke Program Early CT Score (ASPECTS) and core volume measurements. While computed tomography perfusion combined with noncontrast CT hypodensities offers more precise evaluation, standardization remains needed across clinical settings.
Key limitations include restricted data on:
- Patients older than 85 years
- Treatment beyond 12 hours from symptom onset
- Very large core volumes (ASPECTS 0-2) beyond 6 hours
- Patients with prestroke disability
The findings suggest expanding EVT consideration for LCIS patients with good prestroke functional status, substantial stroke severity (National Institutes of Health Stroke Scale score ≥6), and internal carotid artery or proximal middle cerebral artery occlusion.
The authors report no conflicts of interest.
