The New England Journal of MedicineTrial of Thrombectomy for Stroke with a Large Infarct of Unrestricted Size

Thrombectomy Shows Promise in Managing Large Acute Strokes

This study examines the efficacy and safety of thrombectomy in patients experiencing acute strokes with extensive infarcts, where traditional treatment modalities have limited success. By providing a detailed comparison of outcomes between thrombectomy combined with medical care versus medical care alone, the research offers significant insights into stroke management strategies.

Study Design:

• Participant Selection: Patients with acute strokes due to proximal cerebral vessel occlusion and significant infarcts (Alberta Stroke Program Early Computed Tomographic Score ≤5) within 6.5 hours of symptom onset were enrolled.
• Randomization and Groups: Participants were randomly assigned in a 1:1 ratio to either undergo thrombectomy plus medical care or receive medical care alone.
• Trial Context: The study included 333 patients but excluded 9 due to consent withdrawal or legal reasons. The trial was prematurely stopped due to emerging data from similar studies favoring thrombectomy.

Key Findings:

• Functional Outcomes: Patients in the thrombectomy group showed significantly better functional outcomes, with a median modified Rankin scale score of 4, compared to 6 in the control group (generalized odds ratio, 1.63; P<0.001).
• Mortality Rates: Thrombectomy patients had a lower 90-day mortality rate (36.1%) compared to those receiving only medical care (55.5%).
• Safety Concerns: Increased incidence of symptomatic intracerebral hemorrhage was noted in the thrombectomy group (9.6% vs. 5.7% in the control group).

HCN Medical Memo
The study demonstrates that, although thrombectomy leads to better functional recovery and reduced mortality in severe stroke cases, it also raises concerns about an increased risk of hemorrhagic complications. This duality emphasizes the need for careful patient selection and management strategies in clinical practice to balance benefits and risks effectively.

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