Results from research study conducted at University Hospitals, Cleveland, Ohio, showed that endovascular thrombectomy plus medical management is more effective in patients with large strokes compared to patients receiving only standard medical management.

The global study, dubbed SELECT2, was led by University Hospitals stroke director Amrou Sarraj, and study results were published in New England Journal of Medicine.

SELECT2 was conducted at 31 medical centres in North America, Europe, Australia, and New Zealand, was terminated early based on successful results.

Endovascular thrombectomy is the most commonly performed procedure for mechanical removal of a thrombus (blood clot) under image guidance.

The study global principal investigator and lead author Amrou Sarraj said: “We went on to challenge the current practice where patients with large strokes would be precluded from thrombectomy.

“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.

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

According to the research publication, thrombectomy has proven to be effective in smaller strokes, and patients with large strokes are at high-risk for the procedure.

The study was designed to enrol 560 patients with large artery occlusion, determined by a large stroke on CT or advanced imaging.

However, the data and safety monitoring board terminated the trial after enrolling 352 patients, because of the superior outcomes seen with thrombectomy.

The patients were randomly were divided into two groups, where 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.

Stryker Neurovascular supported the trial by providing funding to the University Hospitals Cleveland Medical Centre and University of Texas Houston McGovern Medical School.

Sarraj added: “We found that almost 20 percent 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 7 percent for medical treatment only.

“We also found that almost 40 percent 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.”