Amrou Sarraj, MD, Case Western Reserve University School of Medicine, Cleveland, OH, shares practice-changing findings from the SELECT2 trial (NCT03876457) of endovascular thrombectomy (EVT) versus best medical management (BMM) for ischemic stroke with a large ischemic core. To date, there has been a paucity of randomized, controlled data in the large core population, preventing the extension of the EVT guidelines to include these cases. SELECT2 therefore aimed to determine the safety and efficacy of EVT within 24 hours from last known well, in patients with ASPECTS 3-5 on non-contrast CT or core volume ≥50ml on CT perfusion/MRI. The trial was halted at the planned interim analysis of the first 300 enrollees, as a prespecified efficacy boundary was crossed. The final analysis of all 352 participants showed a statistically significant shift towards improved mRS scores at 90 days with EVT use, compared to BMM (GenOR 1.51). Rates of functional independence and independent ambulation were also improved in the IVT arm, compared to the BMM group. Dr Sarraj comments on the need for further analyses of the role of advanced imaging in patient selection in SELECT2, as well as subgroup analyses. This interview took place during the International Stroke Conference (ISC) 2023 in Dallas, TX.
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Dr Sarraj reports the following disclosures:
Principal investigator, SELECT and SELECT2 trials funded by Stryker neurovascular through grants to University Hospitals Cleveland Medical Center and UT McGovern Medical School.
Member of speaker bureau for Stryker Neurovascular.
Consultation fees from Genentech.