SNIS Highlights New Studies Showing More Stroke Patients Can Benefit From Thrombectomy

February 27, 2023—The Society of NeuroInterventional Surgery announced the publication of a commentary suggesting that access to thrombectomy should be expanded to include more patients who have experienced large vessel occlusion stroke, offering them a better chance of regaining essential cognitive and physical functions.

Michael Chen, MD, et al, published “Large Core Stroke Thrombectomy: Paradigm Shift or Futile Exercise?” online in Journal of NeuroInterventional Surgery.

According to SNIS, the authors cited the results of three randomized clinical trials that show mechanical thrombectomy significantly improved the functional outcomes and likelihood of independence in patients who presented to a hospital with larger amounts of irreversible damage (infarct core) before the procedure. In these recent trials, patients were up to three times more likely to have a positive outcome with thrombectomy than those without.

SNIS noted that earlier trials of thrombectomy have shown dramatic benefit in patients with small- and medium-sized infarct cores, but possible benefit of thrombectomy on larger-core patients was unknown. However, the three latest trials (RESCUE Japan LIMIT, SELECT2, and ANGEL-ASPECT) evaluated patients with a sizeable amount of core damage and randomized them to either thrombectomy or medical management. Results showed there is a clear benefit of thrombectomy for these patients who likely would have been bedridden without the treatment, stated SNIS.

The studies were published as follows:

• On April 7, 2022, the RESCUE Japan LIMIT findings were published in “Endovascular Therapy for Acute Stroke with a Large Ischemic Region” by Shinichi Yoshimura, MD, et al in The New England Journal of Medicine (2022;386:1303-1313).
• On February 10, 2023, SELECT2 findings were published online in “Trial of Endovascular Thrombectomy for Large Ischemic Strokes" by Amrou Sarraj, MD, et al in The New England Journal of Medicine.
• On February 10, 2023, the ANGEL-ASPECT findings were published online in “Trial of Endovascular Therapy for Acute Ischemic Stroke with Large Infarct" by Xiaochuan Huo, MD, et al in The New England Journal of Medicine.

As reported in the society’s press release, SNIS President J Mocco, MD, asserted that the results of these publications will lead to more thrombectomy transfers, simpler imaging for identifying candidates, and, most importantly, a cumulative reduction in the degree of stroke disability and burden to patients and their loved ones.

Dr. Mocco, Kalmon D. Post Professor of Neurosurgery at the Icahn School of Medicine and Director of the Cerebrovascular Center at Mount Sinai in New York, New York, commented in the SNIS press release, “One of the biggest concerns patients and their families have about stroke is that they will be bedridden and fully dependent on others for care. Now we have an opportunity to improve functional independence for even the most severe stroke patients. These findings further support the notion that every patient should be triaged to the most appropriate care, so they are given a chance to survive and thrive.”