Background and purpose Endovascular therapy (EVT) is recommended for acute cerebral large vessel occlusion (LVO) with ASPECTS 6 or more, according to the inclusion criterions of previous randomized controlled trials (RCTs). The purpose of this study was to elucidate the effectiveness of EVT for the patients with large infarction.

Methods Based on the data of ‘RESCUE-Japan Registry 2’ (46 facilities, registration period from October 1, 2014 to September 30, 2016) on acute cerebral LVO led by RESCUE-Japan study group, patients of large cerebral infarction caused by internal carotid artery (ICA) or M1 segment of middle cerebral artery (M1) occlusion with DWI ASPECTS 5 or less (DWI-ASPECTS 0–5) were extracted, and the effectiveness of EVT was statistically examined. Primary endpoint was defined as a moderate functional outcome group (modified Rankin Scale: mRS 3 or less [mRS 0–3]) after 90 days.

Result A total of 2399 people were registered in RESCUE-Japan Registry 2. Among them, 456 patients with ICA or M1 occlusion and DWI-ASPECTS 0–5, and 160 (35.1%) were treated with endovascular therapy (EVT group), and 296 (64.9%) without (Non-EVT group). Primary outcome: the moderate functional outcomes in the patients with DWI-ASPECTS 0–5 were significantly more frequently observed in the EVT group than those in the Non-EVT group (36.3% vs 8.5%; p<0.0001; adjusted OR 3.55 [1.92–6.57]). Safety outcome: data on any intracranial hemorrhage (ICH) were available for 411 of 456 patients. The rate of any ICH and symptomatic ICH did not significantly differ in the EVT and the Non-EVT groups. In mortality rate, there was no significant difference between them, but tend to be lower in the EVT group.

Conclusions This study suggested that EVT was effective even for the LVO patients with large infarctions. RCTs seems to be necessary to elucidate the effectiveness of EVT for low-ASPECTS in the future.

Disclosures H. Kakita: None. S. Yoshimura: 1; C; Medtronic, Medicos Hirata, Termo, Bristal-Myers Squibb, Otsuka. 3; C; Boehringer-Ingelheim, Otsuka, Bayer, Sanofi, Phizer, Bristal-Myers Squibb, Stryker, Medtronic, Mitsubishi Tanabe. K. Uchida: None. N. Sakai: 1; C; Termo. 2; C; Medtronic, Jimro. 3; C; Jimro, Otsuka, Johnson and Johnson, Medtronic, Stryker, Medico’s Hirata. H. Yamagami: 1; C; Bristol-Myers Squibb. 2; C; Daiichi-Sankyo, Boehringer Ingelheim. 3; C; Bayer, Daiichi-Sankyo, Bristol-Myers Squibb, Boehringer Ingelheim, Stryker. T. Morimoto: 1; C; Nexis. 2; C; Asahi Kasei, Boston Scientific, Bristal-Myers Squibb. 3; C; AbbVie, AstraZeneca, Daiichi Sankyo, Kyorin, Mitsubishi Tanabe, Phizer. 6; C; Phizer.