EVT Outcomes in Large Core
Endovascular Thrombectomy Outcomes in Large Core on CT Are Strongly Associated With Perfusion Core Volume and Time
Implications From Two Large Cohorts for Future Trials
Key Findings
Clinical and safety outcomes for large core endovascular thrombectomy declined as the core volume increased and as the time since stroke onset increased.
Purpose: To evaluate the safety and efficacy of endovascular thrombectomy (EVT) on large core on CT.
Trial Design: combined cohort (SELECT and TREVO); large core was ASPECTS ≤5. N=221. CTP measured core volume and blood flow.
Primary Endpoints: 90 day mRS - good 0-2, stratified by perfusion volume.
| CTP core volume | Good outcome (35% for ASPECTS ≤5) | Neurological worsening | Mortality |
| <50cc | 48% | 4% | 4% |
| 50-100cc | 20% | 22% | 30% |
| >100cc | 0% | 100%. | 50% |
| p | 0.03 trend | 0.001 trend | 0.006 trend |
| sICH rates: 4% for ≤100 volume vs 75% for >100cc volume. | |||
| 27% decrease in likelihood of good outcome for every 10cc increase in CPT core volume | |||
Results: Clinical and safety outcomes for large core endovascular thrombectomy on CT ASPECTS declined as the core volume increased and as the time since stroke onset increased.
Endovascular Thrombectomy Outcomes in Large Core
Peter Panagos, MD interviews Amrou Sarraj, MD about his recent work on endovascular thrombectomy outcomes in large core, which he presented in multiple sessions for ISC 2019.
Detailed Results
Results: Clinical and safety outcomes for large core endovascular thrombectomy declined as the core volume increased and as the time since stroke onset increased.
- 27% decrease in likelihood of good outcome for every 10cc increase in CPT core volume
- sICH rates: 4% for ≤100 volume vs 75% for >100cc volume
- Good outcome rates decreased with increasing CTP core volume: (<50cc: 48%, 50-100cc: 20%, >100cc: 0% (p trend=0.03)
- Longer time from onset associated with reduced good outcomes
- Increasing CTP volume:
| CTP Core Volume | Worse Neurological | Death |
| P trend = <0.001 |
P trend = 0.006 |
|
| <50cc | 4% | 4% |
| 50-100cc | 22% | 30% |
| >100cc | 100% | 50% |
Background
Trial Design — combined cohort (SELECT and TREVO); N=221 patients with large core (ASPECTS ≤5). CTP measured core volume and blood flow.
Primary Endpoints — 90-day mRS - good 0-2
Sponsor and Collaborators — UT Health Science Center at Houston, Houston, TX
References
- Presented by Amrou Sarraj at International Stroke Conference 2019, Honolulu, Hawaii
- Sarraj's Abstract
- Sarraj's Presentation Slides (PDF)
Related Science
- Also presented at ISC19 by Sarraj:
Key Words
Large core, intracerebral hemorrhage, stroke endovascular thrombectomy
Related Clinical Topics
Stroke, intracerebral hemorrhage, rehabilitation, functional outcome, ischemic stroke, modified Rankin Scale, surgery