Functional outcomes and quality of life after endovascular thrombectomy in large and extensive infarcts (ASPECTS 0–5): a multicentre registry study

INTRODUCTION: Endovascular thrombectomy (EVT) is established for large infarcts, but remains cautiously applied in extensive infarcts with an Alberta Stroke Program Early CT Score (ASPECTS) of 0-2. Real-life outcome data remain limited. PATIENTS AND METHODS: Retrospective analysis of the German Stroke Registry-Endovascular Treatment comparing extensive (ASPECTS 0-2) and large infarcts (ASPECTS 3-5) in patients with anterior-circulation occlusion and EVT. The primary outcome was the ordinal 90-day mRS distribution; secondary outcomes were mRS 0-3, survival, quality of life (3-level European Quality of Life-5 Dimensions) and living condition. RESULTS: Of 18,069 screened patients, 889 were analysed (ASPECTS 1-2, n = 89; ASPECTS 3-5, n = 800); none had ASPECTS 0. With ASPECTS 1-2, 20.2% achieved mRS 0-3 and 55.1% died within 90 days. In the model including successful reperfusion, no statistically significant association was detected between infarct group and the 90-day mRS distribution (common odds ratio [cOR] 0.80; 95% CI, 0.53-1.23) or mRS 0-3 (adjusted odds ratio [aOR] 0.89; 95% CI, 0.64-1.25), whereas successful reperfusion was associated with both (cOR 3.68; 95% CI, 2.31-5.85 and aOR 4.10; 95% CI, 2.45-6.86). Among survivors, median European Quality of Life-5 Dimensions utility index was 0.445 vs 0.541 (n = 27/324), and 51.5% vs 50.9% lived at home (n = 33/411). DISCUSSION: An extensive infarct carried a challenging prognosis, yet acceptable outcome and non-institutional living remained achievable in a relevant minority. An independent association of infarct group with outcome was not detected. CONCLUSION: An acceptable outcome remained attainable in selected patients with extensive infarction, particularly after successful reperfusion. Lacking a medically managed comparator, these data describe prognosis rather than treatment effect.