Endovascular thrombectomy may not significantly improve 90-day functional outcomes in patients who experienced strokes with large infarcts detected by noncontrast computed tomography, according to a recent trial.

In the randomized clinical trial, published in JAMA, researchers assessed the efficacy of endovascular thrombectomy in patients with large infarcts detected by noncontrast computed tomography (CT) within 24 hours of stroke onset. The Thrombectomy for Emergent Salvage of Large Anterior Circulation Ischemic Stroke trial included 300 patients with anterior circulation large-vessel occlusion and Alberta Stroke Program Early CT Scores of 2 to 5. The patients were randomly assigned to receive either thrombectomy combined with medical management (n = 152) or medical management alone (n = 148).

The primary outcome was the 90-day utility-weighted modified Rankin Scale (UW-mRS), where scores range from 0 (death or severe disability) to 10 (no symptoms). The mean UW-mRS score in the thrombectomy group was 2.93 compared with 2.27 in the control group, resulting in an adjusted difference of 0.63 (95% credible interval [CI] = –0.09 to 1.34). The posterior probability for thrombectomy superiority was 0.96, falling below the prespecified threshold of 0.975.

Mortality rates were comparable between the groups: 35.3% for the thrombectomy group and 33.3% for the control group. Additionally, the rates of symptomatic intracranial hemorrhage were higher in the thrombectomy group (4.0% vs. 1.3%), as well as increased rates of subarachnoid hemorrhage (16.2% vs. 6.2%).

The findings indicated that while thrombectomy did not significantly improve functional outcomes, the CI included the possibility of benefit. Further research is warranted to evaluate the role of thrombectomy in patients with large infarcts identified through noncontrast CT.

Full disclosures can be found in the published trial.