Platform Presentation The Joint Annual Meeting of the Stroke Society of Australasia (SSA) and Smartstrokes 2023

The Effect of Ischemic Core Volume on Functional Outcomes in the SELECT-2 Randomised Trial of Thrombectomy for Large Ischemic Stroke (#16)

Bruce Campbell 1 , Vignan Yogendrakumar 1 , Felix Ng 1 , Leonid Churilov 2 , Hannah Johns 2 , Deep Pujara 3 , Mark W Parsons 4 , Amrou Sarraj 3
  1. Royal Melbourne Hospital, Parkville, VIC, Australia
  2. Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
  3. Neurology, University Hospitals , Cleveland, Ohio, USA
  4. Neurology, Liverpool Hospital, University of New South Wales, Sydney, New South Wales, Australia

Background: Endovascular thrombectomy eligibility is expanding to patients with more extensive ischemic injury based on the results of randomised trials.

Aims: We aimed to investigate the effect of ischemic core volume on functional outcomes with endovascular thrombectomy versus medical management in the SELECT-2 randomised trial.

Methods: SELECT-2 randomised 352 patients with >50mL ischemic core on CT-perfusion and/or ASPECTS 3-5 on non-contrast CT to endovascular thrombectomy versus medical management 0-24h after stroke onset. CT-perfusion was processed with RAPID software using a relative cerebral blood flow threshold <30% of normal brain to estimate ischemic core. The region of pre-treatment non-contrast CT hypodensity was also manually outlined. Follow-up infarct lesions on diffusion MRI or CT scans were also outlined. The treatment effect of thrombectomy on the ordinal modified Rankin scale (mRS) and mRS 0-2/0-3 dichotomies will be analysed in subgroups of ischemic core volume categorised as <70mL, 70-100mL, 100-150mL and >150mL using CT-perfusion, non-contrast CT or the larger of the two. The probability of mRS 0-2 and 0-3 with successful endovascular reperfusion across a spectrum of core volume, age and time to treatment will be presented using heat-map plots to assist clinical prognostication. Infarct growth and the rates of overestimation of baseline ischemic core volumes will be reported.

Results: Data have been collated and re-processed. Late-breaking results will be ready for presentation at the conference.

Conclusion: The decision to treat patients with very large ischemic core volumes can be challenging. These data will clarify the effect of thrombectomy in the larger range of ischemic core volumes.