SELECT2
Trial question
What is the role of endovascular thrombectomy in patients with large ischemic stroke?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
41.0% female
59.0% male
N = 352
352 patients (145 female, 207 male).
Inclusion criteria: patients with stroke due to occlusion of the internal carotid artery or the first segment of the middle cerebral artery.
Key exclusion criteria: inability to undergo computerized tomography angiography and/or computerized tomography perfusion imaging; comorbid psychiatric or medical illnesses; evidence of intracranial tumor, acute ICH, neoplasm, or AVM.
Interventions
N=178 thrombectomy (endovascular thrombectomy plus medical care).
N=174 medical care (medical care alone).
Primary outcome
Median modified Rankin Scale score at day 90
4 points
5 points
5.0 points
3.8 points
2.5 points
1.3 points
0.0 points
Thrombectomy
Medical
care
Significant
decrease ▼
Significant decrease in median mRS score at day 90 (4 points vs. 5 points; OR 0.66, 95% CI 0.52 to 0.83).
Secondary outcomes
Significant increase in functional independence at day 90 (20.3% vs. 7%; RR 2.97, 95% CI 1.6 to 5.51).
Significant increase in independent ambulation at day 90 (37.9% vs. 18.7%; RR 2.06, 95% CI 1.43 to 2.96).
No significant difference in early neurologic improvement (11.5% vs. 7.6%; RR 1.47, 95% CI 0.76 to 2.87).
Safety outcomes
No significant differences in symptomatic ICH, death at day 90.
Conclusion
In patients with stroke due to occlusion of the internal carotid artery or the first segment of the middle cerebral artery, thrombectomy was superior to medical care with respect to median mRS score at day 90.
Reference
Amrou Sarraj, Ameer E Hassan, Michael G Abraham et al. Trial of Endovascular Thrombectomy for Large Ischemic Strokes. N Engl J Med. 2023 Apr 6;388(14):1259-1271.
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