Science, Medicine, and the Anesthesiologist

Although many trials have shown improved early recovery in patients with large ischemic stroke treated with endovascular thrombectomy, it is unknown whether this translates into long-term benefit. The SELECT2 study was a phase 3, open-label randomized controlled trial with blinded outcome assessment. Patients (median [interquartile range] age, 66 [58 to 75] yr) who had no previous neurologic disability, and who had suffered large (more than 50 ml) ischemic brain infarctions caused by occlusion of the internal carotid or middle cerebral arteries, were recruited and assigned to either medical care (n = 174) or medical care plus thrombectomy (n = 178) treatment groups. The prespecified primary outcome consisted of the ordinal modified Rankin Score at 1 yr after the stroke (0 = no symptoms, 6 = death). The trial was terminated early on efficacy grounds. Compared with the medical care–only group, the thrombectomy group had 1.53-fold (95% CI, 1.23 to 1.90; P = 0.002) lower Rankin Scores and 3.32-fold (95% CI, 1.90 to 5.80) better functional independence. There was no significant difference in 1-yr mortality between the groups (45% vs. 52%; relative risk, 0.89 [95% CI, 0.71 to 1.11]). The effect of thrombectomy treatment was not altered by age, stroke severity or volume, or time to intervention.

Take home message: In patients who have suffered large-volume ischemic stroke, endovascular thrombectomy may not greatly alter their mortality but substantially improves their long-term quality of life.