Introduction The recent thrombectomy trials were largely limited to patients with small strokes on presentation. We evaluate the outcomes of thrombectomy in patients with large strokes on baseline imaging.

Methods Patients were derived from a large prospective multicenter international stent-retriever registry (n=2,010). Baseline NCCT-ASPECTS and Infarct Core Volumes on CT perfusion (rCBF<30%) were independently adjudicated by a Core Lab. Baseline and outcome variables were compared according to ASPECTS 0–5 vs 6–10 on baseline NCCT as well as to large age-adjusted cores (<70 mL if age ≤70 years; >50 mL if age <70–80 years; <30 mL if age <80 years) vs not on baseline CTP. The primary and secondary efficacy endpoint were the rates of 90-day mRS 0–2 and mTICI 2b–3, respectively. Safety endpoints included sICH and 90-day mortality.

Results A total of 1,193 patients were included in the ASPECTS analysis. As compared with patients with higher baseline ASPECTS, low baseline ASPECTS (0–4, n=78; 5, n=78) patients were generally younger, had higher stroke severity, and tend to have less comorbidities and undergo thrombectomy at later times (table 1a). TICI-3 reperfusion was higher in the higher-ASPECTS group but other reperfusion outcomes were similar. Safety was comparable. 90-day mRS 0–2 rates were significantly higher in the high-ASPECTS group (p<0.001); however, 41.8% of ASPECTS 0–5 patients were independent at 90 days and safety outcomes were comparable (table 1b). Analysis according to large age-adjusted core (n=86) vs not yielded similarly encouraging results (table 2a–b).

Conclusion Patients with large baseline cores may still achieve favorable outcomes with endovascular treatment.

Disclosures R. Nogueira: 2; C; Stryker Neurovascular. D. Liebskind: 2; C; Stryker Neurovascular. E. Veznedaroglu: 2; C; Stryker Neurovascular. R. Budzik: 2; C; Stryker Neurovascular. R. Gupta: 2; C; Stryker Neurovascular.