Endovascular Thrombectomy Improves Functional Outcomes Long Term in Patients with Large Vessel Occlusion Ischemic Stroke

Endovascular thrombectomy (EVT) improved functional outcomes in patients with anterior circulation large vessel occlusion ischemic stroke and large ischemic core at 1 year of follow up, according to long-term results from the SELECT2 clinical trial (NCT03876457). EVT also met secondary outcomes assessed in the study, with patients who received the procedure showing improved functional independence and independent ambulation. The study results were published in The Lancet and presented at the American Stroke Association’s International Stroke Conference 2024.

SELECT2 was a prospective, randomized, multicenter, open-label, phase 3 clinical trial that enrolled 352 participants aged 18 to 85 years with anterior large vessel occlusion acute ischemic stroke with a large core as defined by Alberta stroke programme early CT score (ASPECTS), perfusion imaging, or MRI diffusion imaging. Participants were recruited from 31 sites across the United States, Canada, Europe, Australia, and New Zealand. Participants received either EVT plus medical care or medical care alone.

In this new analysis of data from the 1 year follow up, the primary outcome measure was modified Rankin Scale (mRS) score at 1 year, with scores 5 and 6 merged. Secondary outcomes assessed included functional independence defined by an mRS score of 0 to 2, independent ambulation defined by an mRS score of 0 to 3, complete dependency or death defined by an mRS score of 5 to 6, and quality of life defined by NeuroQoL.

Participants who received EVT showed a Wilcoxon-Mann-Whitney (WMW) measure of superiority of 0.59 compared with those who received only medical treatment (95% CI, 0.53 to 0.64). The finding corresponds approximately to a 60% probability that a patient treated with EVT plus medical management will have better functional outcomes than a patient who is treated with medical management alone. Additionally, participants treated with EVT showed improved secondary outcomes of functional independence and independent ambulation.

The long-term outcome results of the SELECT2 trial were presented by Amrou Sarraj, MD, FAHA, who is affiliated with Case Western Reserve University and University Hospitals Neurological Institute