EVT Outcomes in Large Core

Details from 2 Cohort Trials

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.

EVT Large Core
CTP core
volume
Good outcome
(35% for ASPECTS ≤5)
Neurological
worsening
Mortality
<50cc48%4%4%
50-100cc20%22%30%
>100cc0%100%.50%
p0.03 trend0.001 trend0.006 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 Volume
CTP Core VolumeWorse NeurologicalDeath
 P trend = <0.001P trend = 0.006
<50cc4%4%
50-100cc22%30%
>100cc100%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

Related Science

Key Words
Large core, intracerebral hemorrhage, stroke endovascular thrombectomy

Related Clinical Topics
Stroke, intracerebral hemorrhage, rehabilitation, functional outcome, ischemic stroke, modified Rankin Scale, surgery

See more science from ISC 2019