Thrombectomy for Stroke With Large Infarct on Noncontrast CT: The TESLA Randomized Clinical Trial.

Area of Science:

• Neurology
• Interventional Neurology
• Stroke Medicine

Background:

• Large infarct thrombectomy trials have used varied imaging and time windows for patient selection.
• Noncontrast computed tomographic (CT) scans are standard for stroke imaging.
• Effectiveness of thrombectomy for large infarcts identified by noncontrast CT within 24 hours remains uncertain.

Purpose of the Study:

• To evaluate the efficacy of thrombectomy in patients with large infarcts identified by noncontrast CT within 24 hours of stroke onset.

Main Methods:

• A randomized trial involving 300 patients with large anterior-circulation, large-vessel occlusion infarcts on noncontrast CT (Alberta Stroke Program Early CT Scores 2-5) within 24 hours.
• Patients were randomized to thrombectomy plus usual care or usual care alone.
• The primary outcome was functional outcome at 90 days, measured by utility-weighted modified Rankin Scale (UW-mRS) scores.

Main Results:

• Thrombectomy did not demonstrate a significant improvement in 90-day functional outcomes (mean UW-mRS: 2.93 vs 2.27).
• The posterior probability for thrombectomy's superiority was 0.96, falling short of the statistical significance threshold.
• 90-day mortality rates were similar between groups (35.3% vs 33.3%), but thrombectomy was associated with higher rates of symptomatic and radiographic intracranial hemorrhage.

Conclusions:

• Thrombectomy did not prove effective for large infarcts identified by noncontrast CT within 24 hours.
• The study's results suggest that this imaging approach and time window may not be optimal for selecting thrombectomy candidates.
• Additional research is required to determine the precise role of thrombectomy in this specific patient group.