Thrombectomy impractical, may do more harm in patients with extensive stroke

Endovascular treatment (EVT) confers no benefit to patients with extensive stroke and may even contribute to an increased risk of haemorrhage and mortality, with the elderly being at the highest risk, a study has found.

The retrospective study involved 248 patients with extensive baseline infarcts (Alberta Stroke Program Early Computed Tomography [CT] Score ≤5) attributed to anterior circulation stroke. Half of the population underwent EVT while the other half received best medical treatment.

The primary functional endpoints were rates of good (modified Rankin Scale score of ≤3) and very poor outcome (modified Rankin Scale score of ≥5) at 90 days. Symptomatic intracerebral haemorrhage was designated as the secondary safety endpoint.

There was no significant difference in the number of patients who achieved good functional outcome in the EVT and best medical treatment group (27.4 percent vs 25 percent; p=0.665). Factors independently associated with very poor outcome were advanced age (adjusted odds ratio [aOR], 1.08, 95 percent confidence interval [CI], 1.05–1.10; p<0.001) and symptomatic intracerebral haemorrhage (aOR, 6.35, 95 percent CI, 2.08–19.35; p<0.001).

In terms of secondary outcomes, patients in the EVT vs best medical treatment group had higher mortality (43.5 percent vs 28.9 percent; p=0.025) and developed symptomatic intracerebral haemorrhage more frequently (16.1 percent vs 5.6 percent; p=0.008).

The lowest rates of good functional outcome (≈15 percent) were observed among patients with failed and partial recanalization (modified Thrombolysis in Cerebral Infarction Scale score of 0/1–2a). On the other hand, patients with complete recanalization (modified Thrombolysis in Cerebral Infarction Scale score of 3) with recanalization attempts ≤2 benefitted the most with EVT (modified Rankin Scale score of ≤3).