NYMC Faculty Publications
Trial of Endovascular Thrombectomy for Large Ischemic Strokes
Author Type(s)
Faculty
Journal Title
The New England Journal of Medicine
First Page
1259
Last Page
1271
Document Type
Article
Publication Date
4-6-2023
Department
Neurosurgery
Abstract
BACKGROUND: Trials of the efficacy and safety of endovascular thrombectomy in patients with large ischemic strokes have been carried out in limited populations.
METHODS: We performed a prospective, randomized, open-label, adaptive, international trial involving patients with stroke due to occlusion of the internal carotid artery or the first segment of the middle cerebral artery to assess endovascular thrombectomy within 24 hours after onset. Patients had a large ischemic-core volume, defined as an Alberta Stroke Program Early Computed Tomography Score of 3 to 5 (range, 0 to 10, with lower scores indicating larger infarction) or a core volume of at least 50 ml on computed tomography perfusion or diffusion-weighted magnetic resonance imaging. Patients were assigned in a 1:1 ratio to endovascular thrombectomy plus medical care or to medical care alone. The primary outcome was the modified Rankin scale score at 90 days (range, 0 to 6, with higher scores indicating greater disability). Functional independence was a secondary outcome.
RESULTS: The trial was stopped early for efficacy; 178 patients had been assigned to the thrombectomy group and 174 to the medical-care group. The generalized odds ratio for a shift in the distribution of modified Rankin scale scores toward better outcomes in favor of thrombectomy was 1.51 (95% confidence interval [CI], 1.20 to 1.89; P
CONCLUSIONS: Among patients with large ischemic strokes, endovascular thrombectomy resulted in better functional outcomes than medical care but was associated with vascular complications. Cerebral hemorrhages were infrequent in both groups. (Funded by Stryker Neurovascular; SELECT2 ClinicalTrials.gov number, NCT03876457.).
Recommended Citation
Sarraj, A., Hassan, A. E., Abraham, M. G., Ortega-Gutierrez, S., Kasner, S. E., Hussain, M. S., Chen, M., Blackburn, S., Sitton, C. W., Churilov, L., Sundararajan, S., Hu, Y. C., Herial, N. A., Jabbour, P., Gibson, D., Wallace, A. N., Arenillas, J. F., Tsai, J. P., Budzik, R. F., Hicks, W. J., … SELECT2 Investigators (2023). Trial of Endovascular Thrombectomy for Large Ischemic Strokes. The New England journal of medicine, 388(14), 1259–1271.
Comments
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