Endovascular Thrombectomy in Patients With Largest Baseline Infarcts (ASPECTS 0–2): An Ancillary Analysis of the LASTE Trial

BACKGROUND: Endovascular thrombectomy (EVT) has demonstrated benefits in patients with ischemic stroke and large-vessel occlusions, but its efficacy and safety in patients with the largest baseline infarcts (Alberta Stroke Program Early Computed Tomography Score [ASPECTS] 0-2), remain controversial. This study aimed to evaluate the efficacy and safety of EVT in early presenting patients with ASPECTS 0 to 2 compared with medical care alone. METHODS: This post hoc analysis of the multicenter, randomized LASTE trial (patients ≤80 years, ASPECTS 0-5, proximal anterior circulation large-vessel occlusion, randomization within 6.5 hours of last known well) evaluated the subgroup with ASPECTS 0 to 2, representing those with large baseline infarcts without an upper size limit, randomized to receive EVT plus medical care or medical care alone. Primary outcomes included the distribution of the modified Rankin Scale score at 90 days. Secondary outcomes included mortality, infarct volume growth at 24 hours, the incidence of symptomatic intracranial hemorrhage and modified Rankin Scale score at 180 days. The LASTE trial was conducted and reported in accordance with the CONSORT guidelines. RESULTS: Median age was 72 years and 55.8% were women. Among the 181 patients with ASPECTS 0 to 2 (median core volume 156 mL [25th-75th percentiles, 121-204 mL]), at 90 days after randomization, EVT improved functional outcomes (generalized odds ratio, 1.81 [95% CI, 1.32-2.47]) and reduced mortality (38.4% versus 59.6%; relative risk, 0.64 [95% CI, 0.47-0.89]), which translated predominantly into an increase in the proportion of modified Rankin Scale score of 0 to 3 in the EVT group (31.4% versus 8.5%; relative risk, 3.69 [95% CI, 1.77-7.68]). A significant reduction in infarct growth volume was observed in the EVT group compared with medical care (mean difference, -70.3 mL [95% CI, -94.2 to -46.3]). Rates of symptomatic intracranial hemorrhage were 12.9% versus 4.5%, respectively (relative risk, 2.85 [95% CI, 0.94-8.60]). CONCLUSIONS: EVT improves functional outcomes and reduces mortality in patients with ASPECTS 0 to 2. These findings support the concept that in patients aged <80 years presenting within early time window (6.5 hours) with unlimitedly large infarct (predominantly selected using magnetic resonance imaging), the infarct size in isolation should not be used to disqualify patients from endovascular treatment. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03811769.

Authors

Institutions

Publication Details

Journal
Stroke
Published
2026-04-14
DOI
https://doi.org/10.1161/strokeaha.125.054161
Primary Topic
Peripheral Artery Disease Management
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Endovascular Thrombectomy in Patients With Largest Baseline Infarcts (ASPECTS 0–2): An Ancillary Analysis of the LASTE Trial

Arturo Renú, Jean‐Christophe Gentric, Sophie Godard, M Lamy et al.
Stroke
Peripheral Artery Disease Management
article

Endovascular Thrombectomy in Patients With Largest Baseline Infarcts (ASPECTS 0–2): An Ancillary Analysis of the LASTE Trial

Arturo Renú, Jean‐Christophe Gentric, Sophie Godard, M Lamy, Tudor G. Jovin, Julien Labreuche, Nerses Sanossian, Emmanuel Chabert, Benjamin Gory, P. Cardona, Laurent Spelle, Hilde Hénon, Omer F. Eker, Cyril Chivot, Sébastien Richard, Charbel Mounayer, Mariam Annan, Christian Denier, Michaël Obadia, Anna Ferrier, Serge Timsit, Laurent Suissa, A. Pasco-Papon, Michel Piotin, Gaultier Marnat, N Nouri, Sonia Alamowitch, Emmanuel Houdart, Grégoire Boulouis, Stéphane Velasco, Chrysanthi Papagiannaki, Caroline Arquizan, Federico Di Maria, Chantal Lamy, Christophe Cognard, Bertrand Lapergue, J.-F. Albucher, María del Mar Freijo, Hervé Brunel, Pedro Vega, Frederic Ricolfi, Tae‑Hee Cho, Vincent Costalat, Juan F. Arenillas, Elena Lopez‑Cancio, Francisco Macian‑Montoro, David S. Liebeskind, Valerie Wolff, Frederic Clarencon, Igor Sibon, Yannick Bejot, Benoit Guillon, Ozlem Ozkul‑Wermester, Olivier Naggara, Mikael Mazighi, Romain Bourcier, Raoul Pop, Guillaume Turc, Alain Duhamel, Monica Millan
article en

Abstract

BACKGROUND: Endovascular thrombectomy (EVT) has demonstrated benefits in patients with ischemic stroke and large-vessel occlusions, but its efficacy and safety in patients with the largest baseline infarcts (Alberta Stroke Program Early Computed Tomography Score [ASPECTS] 0-2), remain controversial. This study aimed to evaluate the efficacy and safety of EVT in early presenting patients with ASPECTS 0 to 2 compared with medical care alone. METHODS: This post hoc analysis of the multicenter, randomized LASTE trial (patients ≤80 years, ASPECTS 0-5, proximal anterior circulation large-vessel occlusion, randomization within 6.5 hours of last known well) evaluated the subgroup with ASPECTS 0 to 2, representing those with large baseline infarcts without an upper size limit, randomized to receive EVT plus medical care or medical care alone. Primary outcomes included the distribution of the modified Rankin Scale score at 90 days. Secondary outcomes included mortality, infarct volume growth at 24 hours, the incidence of symptomatic intracranial hemorrhage and modified Rankin Scale score at 180 days. The LASTE trial was conducted and reported in accordance with the CONSORT guidelines. RESULTS: Median age was 72 years and 55.8% were women. Among the 181 patients with ASPECTS 0 to 2 (median core volume 156 mL [25th-75th percentiles, 121-204 mL]), at 90 days after randomization, EVT improved functional outcomes (generalized odds ratio, 1.81 [95% CI, 1.32-2.47]) and reduced mortality (38.4% versus 59.6%; relative risk, 0.64 [95% CI, 0.47-0.89]), which translated predominantly into an increase in the proportion of modified Rankin Scale score of 0 to 3 in the EVT group (31.4% versus 8.5%; relative risk, 3.69 [95% CI, 1.77-7.68]). A significant reduction in infarct growth volume was observed in the EVT group compared with medical care (mean difference, -70.3 mL [95% CI, -94.2 to -46.3]). Rates of symptomatic intracranial hemorrhage were 12.9% versus 4.5%, respectively (relative risk, 2.85 [95% CI, 0.94-8.60]). CONCLUSIONS: EVT improves functional outcomes and reduces mortality in patients with ASPECTS 0 to 2. These findings support the concept that in patients aged <80 years presenting within early time window (6.5 hours) with unlimitedly large infarct (predominantly selected using magnetic resonance imaging), the infarct size in isolation should not be used to disqualify patients from endovascular treatment. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03811769.

Stroke
Inserm (FR), Université de Versailles Saint-Quentin-en-Yvelines (FR), Cooper University Hospital (US), Bellvitge University Hospital (ES), Cooper Medical School of Rowan University (US), Centre Hospitalier Universitaire de Tours (FR), Hôpital Bretonneau (FR), Centre Hospitalier Régional et Universitaire de Nancy (FR), Hôpital Roger Salengro (FR), Hôpital Gui de Chauliac (FR), Hôpital Pellegrin (FR), Imagerie Adaptative Diagnostique et Interventionnelle (FR), Paris Cardiovascular Research Center (FR), Hôpital Paule de Viguier (FR), Hôpital Foch (FR), Cooper University Health Care (US), Data Management (Italy) (IT)
Zero hunger
Openalex Percentile: Top 31%
Peripheral Artery Disease Management
DOISourceOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.