Study: Thrombectomy beneficial in high-risk acute stroke patients with large infarct

Editor's Note

Building on previous evidence favoring thrombectomy even in high-risk cases, the prospective randomized LASTE trial finds the surgical procedure could reduce mortality and improve funcational outcomes in patients with acute stroke and large infarct of unrestricted size. Medpage Today reported the news May 8.

Originally published in the New England Journal of Medicine, the study finds a median modified Rankin scale score was 4, indicating moderately severe disability, in the thrombectomy group versus 6 in the control group, indicating death (generalized OR 1.63, 95% CI 1.29-2.06, P<0.001), after 90 days. Death from any cause at 90 days occurred in 36.1% of patients in the thrombectomy group compared with 55.5% of those in the control group (adjusted relative risk [aRR] 0.65, 95% CI 0.50-0.84. Benefits of thrombectomy were sustained at 180 days.

Previous trials of endovascular thrombectomy in acute stroke showed benefits, Medpage reports, but patients with the largest infarcts were excluded due to concerns about injury from reperfusion. Additionally, few had unrestricted infarct size—a contrast with the LASTE trial. "The effect favoring thrombectomy was similar in magnitude to that seen in other thrombectomy trials, including those that only enrolled patients with a small or moderately sized baseline infarct; however, no direct comparisons with other trials can be made because of differences in trial designs and patient populations," researchers wrote.

The full report offers further context on the patient population (high mortality, morbidity, and risk of disability) and the implications of this data, which one expert says adds to evidence supporting incorporation of thrombectomy for such patients into clinical practice guidelines.