Time Still Equals Brain, So Does Core Size for Patients With Large-Core Strokes

Research presented at the International Stroke Conference in Honolulu, HI, showed that poor outcomes for patients with large-core stroke treated with mechanical thrombectomy correlate with both time to thrombectomy and core size. For this study, large-core stroke was defined as 5 or less on the Alberta Stroke Program Early CT Score (ASPECTS) and good outcome as a score of 0 to 2 on the modified Rankin Scale (mRS). 

In patients with large-core stroke (n = 221), the chance of a good outcome was 35% overall, but that decreased by 27% for every 10 mL volume core increase (< 50 mL 48%, 50-100 mL 20%, >100 mL 0%; P trend = 0.3). Substantial decreases in good outcomes were also seen as the time to thrombectomy increased with much lower likelihood of a good outcome when thrombectomy occurred more than 12 hours after last-known-well time.   

These findings suggest that early thrombectomy in patients with large-core stroke of less than 100 mL volume is safe and with benefits the earlier it is done. 

“Outcomes in stroke patients treated with thrombectomy (mechanical clot removal) is affected by the size of the stroke – the larger the stroke, the worse the outcome,” said lead author Amrou Sarraj, MD, associate professor of neurology at McGovern Medical School at The University of Texas Health Science Center at Houston.