Introduction: The recent thrombectomy trials were largely limited to patients with small strokes on presentation.
Methods: Patients derived from a large prospective multinational stent-retriever registry (Trevo Registry, n=2,010). Baseline NCCT SPECTS and CTP Core Volumes (rCBF<30%) were adjudicated by a Core Lab. Baseline and outcome variables were compared for ASPECTS 0-5 vs. 6-10 on NCCT and large age-adjusted cores (>70mL if age <=70 years; >50mL if age >70-80 years; >30mL if age >80 years) vs. not on CTP. The primary and secondary efficacy endpoint were the rates of 90-day mRS 0-2 and mTICI 2b-3, respectively. Safety endpoints included sICH and 90-day mortality.
Results: As compared with patients with higher baseline ASPECTS (n=1037), low baseline ASPECTS (0-4, n=78; 5, n=78) patients were younger, had higher stroke severity, and tend to have less comorbidities and undergo thrombectomy at later times (Table 1a). TICI-3 reperfusion was higher in the higher-ASPECTS group but other reperfusion outcomes were nearly the same. Safety outcomes were comparable. Rates of 90-day mRS 0-2 were significantly higher in the high-ASPECTS group (p<0.001); however, 41.8% of ASPECTS 0-5 patients were independent at 90 days and safety outcomes were similar (Table 1b). Analysis according to large age-adjusted core (n=86) vs not (n=431) yielded similarly encouraging results (Table 2a-b).
Conclusion: Patients with large baseline cores as measured by either NCCT or CTP may still achieve favorable outcomes with endovascular treatment. A randomized clinical trial in this patient population is warranted.