A randomized controlled trial to optimize patient's selection for endovascular treatment in acute ischemic stroke...

Area of Science:

• Neurology
• Interventional Cardiology
• Radiology

Background:

• Randomized evidence for endovascular thrombectomy in large core strokes is limited.
• Current guidelines often exclude patients with large infarct cores from thrombectomy consideration.

Purpose of the Study:

• To evaluate the efficacy and safety of endovascular thrombectomy in patients with large core strokes.
• To determine if imaging modality (CT or perfusion imaging) influences treatment effect heterogeneity.

Main Methods:

• SELECT2 is a prospective, multi-center, randomized controlled trial with an adaptive enrichment design.
• Up to 560 patients with anterior circulation large vessel occlusions and large core strokes (defined by NCCT or perfusion imaging) were randomized 1:1 to endovascular thrombectomy or medical management.
• Treatment continued up to 24 hours from the last known well.

Main Results:

• The primary outcome is the distribution of 90-day modified Rankin Scale (mRS) scores.
• Secondary outcomes include functional independence (mRS 0-2), symptomatic intracranial hemorrhage, neurological worsening, mortality, and imaging findings.
• Analysis will compare outcomes using a generalized likelihood ratio test and other statistical methods.

Conclusions:

• The SELECT2 trial aims to provide randomized evidence on the safety and efficacy of endovascular thrombectomy in large core strokes.
• Results may support expanding thrombectomy eligibility to a broader patient population.
• Registration: ClinicalTrials.gov-NCT03876457.