The following is a summary of “Endovascular thrombectomy for acute ischaemic stroke with established large infarct (TENSION): 12-month outcomes of a multicentre, open-label, randomised trial,” published in the July 2024 issue of Neurology by Thomalla et al.
There is not much long-term data on the benefits of endovascular thrombectomy for strokes with large infarcts. The TENSION trial showed this procedure is safe and effective for patients with ischemic stroke and large infarcts over 90 days.
Researchers conducted a prospective study to check the safety and effectiveness of endovascular thrombectomy at 12 months for patients who took part in the TENSION trial.
They conducted the TENSION trial, an open-label, blinded endpoint, randomized study across 41 hospitals in Europe and Canada. Patients with acute ischemic stroke due to large vessel occlusion and large infarct, as indicated by an Alberta Stroke Program Early Computed Tomographic Score (ASPECTS 3-5), were randomly assigned to endovascular thrombectomy plus medical treatment or medical treatment alone, within 12 hours from stroke onset. The primary outcome was measured using the modified Rankin Scale at 90 days. For the 12-month follow-up, they checked functional outcomes, quality of life (PROMIS-10, EQ-5D), post-stroke anxiety and depression (PHQ-4), and overall survival.
The results showed that between July 2018 and February 2023, 253 patients were enrolled. Of all the patients, 125 (49%) were assigned to endovascular thrombectomy and 128 (51%) to medical treatment only, with a median follow-up of 8.36 (IQR: 0.02-12.00) months. Thrombectomy improved 12-month outcomes on the modified Rankin Scale (aOR 2.39 [95% CI: 1.47-3.90]). It also showed higher quality of life scores on EQ-5D (0.7 [IQR: 0.4-0.9] vs. 0.4 [0.2-0.7]), for health status on EQ-5D (50 [35-70] vs. 30 [5-60]) and PROMIS-10 physical health (T-score 39.8 [37.4-50.8] vs. 37.4 [32.4-44.9]). However, mental health scores (41.1 [36.3-48.3] vs. 38.8 [31.3-44.7]) and anxiety (13 [22%] of 58 vs. 15 [42%] of 36) and depression rates (18 [31%] vs. 18 [50%]) were similar between groups. Overall survival slightly improved with thrombectomy (aHR 0.70 [95% CI: 0.50-0.99]).
Investigators concluded that for patients with acute ischemic stroke and large infarcts, endovascular thrombectomy led to better long-term outcomes in function, quality of life, and survival compared to medical treatment alone, supporting its use.
Source: thelancet.com/journals/laneur/article/PIIS1474-4422(24)00278-3/fulltext#%20\
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