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Thrombectomy ‘can support recovery after large stroke’

Almost 20 per cent of patients who had a thrombectomy achieved functional independence, compared to seven per cent for medical treatment only

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People who experience large strokes can have a significantly better recovery after endovascular thrombectomy and medical management, when compared to patients receiving only standard medical management, new research has revealed. 

The SELECT2 study – which involved 31 medical locations across North America, Europe, Australia, and New Zealand – was stopped early because of the successful results seen in patients who received thrombectomy rather than medication only.

While thrombectomy has proven effective in smaller strokes, patients with large strokes were considered too high risk for the procedure. Size of a stroke is determined by the range of damaged brain tissue seen through CT or MRI scans.

But the international study revealed that almost 20 per cent of the patients who received a thrombectomy ended up with functional independence, compared to seven per cent for medical treatment only. Calls continue to be made for thrombectomy to be given to more patients.

“These patients are left to receive medical management only, and a significant number of them end up with very poor outcomes; being wheelchair bound, bed ridden, or dead,” said Dr Amrou Sarraj, global principal investigator.  

“This is a huge opportunity for improvement at a very large level, especially since these patients account for 20 to 25 per cent of all large vessel occlusions and may have huge impact on patients, their family, and society.”

The study had a target of 560 patients with large artery occlusion causing a large stroke on CT or advanced imaging, but the data and safety monitoring board stopped the trial after enrolment of 352 patients because of the superior outcomes seen with thrombectomy.

The patients were randomly assigned to one of two groups: 178 received thrombectomy and 174 received medical management. Patients who were seen prior to 4.5 hours from onset of stroke received clot-buster drugs TPA or TNKase if eligible.

“We found that almost 20 per cent of the patients who received a thrombectomy ended up with functional independence, going back to their family, to the society as almost normal or not needing support, compared to seven per cent for medical treatment only,” said Dr Sarraj, Stroke Center and System Director, the George M. Humphrey II Chair in Neurology at University Hospitals, and Professor of Neurology at Case Western Reserve University School of Medicine.

“We also found that almost 40 per cent of the patients end up ambulating independently.

“This is a huge improvement in these patients with large strokes who are not being offered the treatment at this point.”

Dr Sarraj expects the results to change treatment guidelines in the near future. 

“This will give a large number of patients the opportunity for a chance for improvement,” he said.

Dr Cathy Sila, Chair of Neurology and the Gilbert W. Humphrey Professor of Neurology at UH and Professor of Neurology at Case Western Reserve, said: “The results of the SELECT2 trial represent another major advancement in acute stroke therapy and brings hope for meaningful recovery to an additional subgroup of patients who previously would have been thought not to benefit. 

“The success of SELECT2 trial is a testament to the dedication and perseverance of Dr Sarraj, the UH stroke team, and his collaborating co-investigators across the world. 

“We are proud to be leading the charge towards a brighter future for patients and their families affected by stroke.”

Dr Grace A. McComsey, Vice President of Research, Associate Chief Scientific Officer and Director, Clinical Research Center at UH, added: “This is yet another great example of how well designed clinical trials can challenge the current knowledge to improve life expectancy and quality of life. 

“I am proud of our team, led by Dr. Sarraj, that scientifically challenged the status quo and showed promise in a devastating condition like stroke.”

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