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Long-term results of mechanical thrombectomy for large ischaemic stroke
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Journal Article
Long-term results of mechanical thrombectomy for large ischaemic stroke
2024
Overview
Acute ischaemic stroke with an extensive core is associated with high mortality rates and post-stroke disability and these patients have been excluded from previous randomised controlled trials. [...]no consensus had been reached about the indication to perform endovascular thrombectomy in patients with acute ischaemic stroke and an extensive ischaemic core. The study compared endovascular thrombectomy plus the best medical care versus the best medical care alone in adult patients with stroke (ie, those aged <85 years) with anterior circulation proximal occlusion (internal carotid artery or first segment of the middle cerebral artery), within 24 h of onset, presenting a large core defined as non-contrast CT Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) 3–5 or a core of 50 mL or more on CT perfusion and MRI. 178 (51%) of 352 patients were randomly assigned to receive endovascular thrombectomy (median age was 66 years [IQR 58–75]; 107 [60%] were men and 71 [40%] were women; 132 [74%] were White, 26 (15%) were Black, five (3%) were Asian, two (1%) were Native Hawaiian or Pacific Islanders, and 13 (7%) had other or unknown ethnicity) whereas 174 (49%) patients were treated with the best medical care only. Similar findings were published in a retrospective analysis with an average follow-up of 3·67 years showing that higher recanalisation grades were associated with better clinical outcomes in patients with low ASPECTS (0–5).11 Finally, as would be expected, patients with large volume strokes are more exposed to cognitive decline and dementia and therefore the burden of the ischaemic lesion on quality of life12 is expected to be higher in this subgroup. [...]to provide an appropriate clinical assessment for patients with large volume strokes, a long-term follow-up beyond the standard 3-month evaluation should be carefully considered in the design of new studies and trials that will have an impact on future guidelines.
Publisher
Elsevier Ltd,Elsevier Limited
