RAPID-LC: rapid evidence-to-practice uptake of large core thrombectomy across a stroke consortium

Area of Science:

• Neurology
• Interventional Neurology
• Stroke Medicine

Background:

• Landmark trials (SELECT2, ANGEL-ASPECT, RESCUE-Japan LIMIT) showed endovascular thrombectomy (EVT) benefits in large ischemic cores (ASPECTS 3-5).
• Limited data existed on real-world EVT adoption for very low ASPECTS (0-2).

Purpose of the Study:

• To evaluate the real-world adoption of EVT in patients with large ischemic stroke cores after publication of key clinical trials.
• To assess changes in EVT utilization across the spectrum of ASPECTS scores, particularly low scores (≤5).

Main Methods:

• Retrospective, multicenter, before-and-after cohort study.
• Compared pre-publication (2021) and post-publication (2024) periods for adult stroke patients with large cores (ASPECTS ≤5 or CT core >70 mL).
• Assessed EVT utilization, functional outcomes (mRS), and mortality; multivariable logistic regression identified predictors of EVT receipt.

Main Results:

• EVT utilization increased from 42% to 60.5% post-publication.
• EVT use in patients with ASPECTS 0-2 rose significantly from 4.3% to 32.5%.
• The year 2024 was the strongest predictor of EVT receipt (aOR 3.11), with ASPECTS score also being a dominant imaging predictor (aOR 7.11 for ASPECTS 3-5 vs 0-2).

Conclusions:

• Publication of large core thrombectomy trials led to substantial increases in EVT use, including for very low ASPECTS patients.
• Clinician adherence to baseline severity considerations appears appropriate, indicating safe translation of evidence into practice.
• Standardized implementation strategies are crucial for optimizing patient outcomes in large-core stroke treatment.