Background: The original Endovascular Clot Retrieval (ECR) trials in HERMES mostly excluded patients with established core volume of more than 70mL based on imaging criteria. Subsequent observational data and recent randomised control trials suggest patients may benefit from ECR with large core volumes, arguing for this exclusion criterion to be revised.
Aims: To identify the number of additional patients who would be eligible for ECR at our Comprehensive Stroke Centre using the SELECT-2 criteria.
Methods: Acute ischemic stroke (AIS) patients with large vessel occlusions (LVO) presenting within 24 hours of onset were screened retrospectively between 01/01/2021 and 28/02/2023. Additionally, all AIS with NIHSS>10, mRS <2 and age <85 who presented within 24 hours were screened for LVO and eligibility for ECR under SELECT-2 criteria.
Results: The total of 660 AIS patients presented to our centre over the 26-month period, with 492 (75%) presenting within 24 hours. 84 patients underwent ECR (median age of 74 years, median NIHSS 14). The median core volume based on CT Perfusion CBF <30% was 7mL. 8 patients had a core volume greater than 70mL (median 100.5mL) with significant core/penumbra mismatch. Of the remaining 408 patients, 141 (35%) were excluded based on high mRS (>1), 50 (12%) on age >85 years, and another 230 (56%) on NIHSS score <10. Amongst the remaining 31 patients, 22 did not have an LVO (ICA or M1). Of 9 patients with LVO, 2 had core volumes greater than 70mL, (167mL and 188mL), one of whom would not have qualified for SELECT-2 based on a low ASPECT score (2).
Conclusion: Retrospective screening using expanded SELECT-2 criteria identified only one additional patient. Therefore, formal adoption of the SELECT-2 criteria would not be expected to significantly affect ECR case load at our centre.