Patients in the thrombectomy plus medical care group reported a significantly lower mRS score at the 1-year follow-up compared to those in the medical care alone group, and 1-year mortality in the thrombectomy group was lower than in the medical care alone group.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Endovascular thrombectomy is known to have good clinical outcomes in patients with ischemic stroke. However, limited data exists regarding its long-term efficacy. This randomized controlled trial aimed to compare the safety and efficacy of endovascular thrombectomy plus medical care versus medical care alone in patients with large-vessel occlusion. The primary outcome was the modified Rankin Scale score (mRNA, range 0-6) at 1-year follow-up while a key secondary outcome was mortality. According to study results, endovascular thrombectomy significantly improved functional outcomes compared to medical care alone, with a lower mortality rate observed in the thrombectomy group at 1-year follow-up. Although this study was well done, it was limited by potential biases inherent in the open-label design.

Click to read the study in The Lancet

Relevant Reading: Trial of Endovascular Thrombectomy for Large Ischemic Strokes

In-depth [randomized-controlled trial]: Between Oct 11, 2019, and Sept 9, 2022, 958 patients were screened for eligibility across 31 hospitals in 6 countries. Included were patients ≥ 18 years of age with ischemic stroke due to occlusion of the internal carotid artery or first segment of the middle cerebral artery. Altogether, 352 patients (178 to thrombectomy plus medical care and 174 to medical care alone) were included in the final analysis. The primary outcome of mRS score at 1-year was significantly lower in the thrombectomy group compared to medical care alone (odds ratio [OR] 1.43, 95% confidence interval [CI] 1.14-1.78), indicating lower disease burden. Furthermore, fewer patients in the thrombectomy group died (n=77, 45%) versus medical care alone (n=83, 52%) at the 1-year follow-up (relative risk 0.89, 95% CI 0.71-1.11). Findings from this study suggest that thrombectomy plus medical care provides a significant functional benefit compared to medical care alone for large vessel ischemic stroke.

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