N Engl J Med

More evidence favors thrombectomy for acute stroke with large infarct size

May 14, 2024

Patients with acute stroke and a large infarct of unrestricted size fared better with thrombectomy plus medical care than medical care alone but had a higher incidence of symptomatic intracerebral hemorrhage. The trial was stopped early because results of similar trials favored thrombectomy.

• In the prospective LASTE trial, 333 patients were assigned to either the thrombectomy group (166 patients) or the control group (167 patients). Approximately 35% of the patients received thrombolysis therapy.
• The median modified Rankin scale score at 90 days was 4 in the thrombectomy group vs. 6 in the control group (generalized odds ratio, 1.63; 95% confidence interval [CI], 1.29 to 2.06; P<0.001).
• Death from any cause at 90 days occurred in 36.1% of the patients in the thrombectomy group vs. 55.5% of those in the control group (adjusted relative risk [aRR], 0.65; 95% CI, 0.50 to 0.84). The percentage of patients with symptomatic intracerebral hemorrhage was 9.6% and 5.7%, respectively (aRR, 1.73; 95% CI, 0.78 to 4.68). Eleven procedure-related complications occurred in the thrombectomy group.

Source:

Costalat V; LASTE Trial Investigators. (2024, May 9). N Engl J Med. Trial of Thrombectomy for Stroke with a Large Infarct of Unrestricted Size. https://pubmed.ncbi.nlm.nih.gov/38718358/