Endovascular therapy improved ischemic stroke outcomes at 1 year

Key takeaways:

• The study examined 352 individuals with stroke randomized to EVT and medical care or medical care alone.
• EVT intervention led to improved functional independence and better ambulation.

DENVER — In patients with ischemic stroke, treatment with endovascular therapy with medical care led to better functional outcomes at 1 year compared with medical care alone. according to a speaker.

“In 2023, we had several trials that were groundbreaking in our field, that showed significant benefit for endovascular therapy for patients who present with large core ischemic stroke,” Amanda Opaskar, MD, a vascular neurologist and assistant professor of neurology at Case Western Reserve University, said during her presentation at the American Academy of Neurology annual meeting.

“The question was how do these patients recover over that longer term, first year.”

Opaskar and colleagues sought to evaluate safety and efficacy of endovascular therapy (EVT) for ischemic stroke in the SELECT2 trial using clinical outcomes at 1-year follow-up. SELECT2 was a phase 3, international, multicenter, prospective, randomized, open-label trial with blinded endpoint assessment.

It included 352 individuals diagnosed with a large ischemic core on non-contrast CT (ASPECTS 3-5) scan, perfusion or MRI who received either EVT and best medical management (n = 178; median age 66 years; 71% female) or best medical management only (n = 174; median age 67 years; 74% female).

The study’s primary outcome was modified Rankin Scale (mRS) score at 1-year follow-up, evaluated using generalized odds ratio (GOR), with secondary outcomes including functional independence (0 to 2 mRS score), independent ambulation (mRS 0 to 3) and quality of life scores at 1-year follow-up.

A total of 93% (329 of 352) of enrollees completed the follow-up, with 23% of those who received EVT recording an mRS score of 0 to 2 compared with 8% of those who received medical care only.

Thrombectomy significantly improved the 1-year mRS score distribution (WMW probability of superiority = 0.59; 95% CI, 0.53-0.64; GOR = 1.43; 95% CI, 1.14-1.78), functional independence (EVT: 24% vs MM: 6%, RR = 3.17; 95% CI, 1.73-5.79) and independent ambulation (EVT: 37% vs MM: 18%, RR =1.85; 95% CI, 1.3-2.63) compared with medical care alone.

Data additionally showed EVT led to better QoL scores in functional independence, mobility, ambulation, sociability, cognition and depression compared with medical care alone.

“It is important to note we think about the potential recovery of these patients both in clinical trial design as well as when we are counseling (them),” Opaskar said. “That their recovery extends not just in 3 months, but it goes longer, up to a full year.”