Trial of Endovascular Thrombectomy for Large Ischemic Strokes
A prospective, randomized, international trial was conducted involving patients with stroke due to occlusion of the internal carotid artery or the first segment of the middle cerebral artery, with participants having a large ischemic-core volume and being assigned to receive either endovascular thrombectomy plus medical care or medical care alone. The primary outcome was the modified Rankin scale score at 90 days, with functional independence as a secondary outcome. The trial was stopped early for efficacy, with 178 patients in the thrombectomy group and 174 in the medical-care group. The thrombectomy group showed better outcomes, with a 1.51 generalized odds ratio for improved modified Rankin scale scores. Functional independence was achieved by 20% of patients in the thrombectomy group and 7% in the medical-care group. Mortality rates were similar between the two groups, but the thrombectomy group experienced some vascular complications. Symptomatic intracranial hemorrhages were infrequent in both groups. Endovascular thrombectomy led to better functional outcomes than medical care alone for patients with large ischemic strokes, although it was associated with vascular complications. Cerebral hemorrhages were rare in both treatment groups.