Thrombectomy Improved Outcomes After Transfer for Large-Core Stroke

Mechanical thrombectomy was associated with better 90-day functional outcomes than medical management alone among patients with large-core ischemic stroke identified before transfer to a comprehensive stroke center, according to a post hoc analysis of the LASTE randomized clinical trial published in Annals of Neurology.

The analysis included patients with anterior-circulation large-vessel occlusion initially evaluated at a primary stroke center. Pretransfer imaging showed a large ischemic core, defined by an Alberta Stroke Program Early Computed Tomography Score (ASPECTS) of 0 to 5. Patients had been randomized within 6.5 hours of last known well to medical management alone or thrombectomy plus medical management.

Of 324 patients enrolled in LASTE, 157 were included; 80 received medical management alone and 77 underwent thrombectomy. Median age was 73 years, median National Institutes of Health Stroke Scale score was 20, and median ASPECTS was 2. At 90 days, thrombectomy produced a more favorable shift across modified Rankin Scale scores (generalized odds ratio, 1.71; 95% CI, 1.21-2.41; P=.002).

Ninety-day mortality was 36.8% with thrombectomy and 50.6% with medical management alone, although the confidence interval included no difference (relative risk, 0.73; 95% CI, 0.50-1.05). Symptomatic intracranial hemorrhage within 24 hours occurred in 12.0% and 6.5%, respectively, also with an imprecise estimate (relative risk, 1.85; 95% CI, 0.64-5.26). No significant heterogeneity in the primary outcome was found between patients with ASPECTS of 0 to 2 and those with scores of 3 to 5.

The authors said the findings support considering transfer for thrombectomy within the early treatment window, including for patients with ASPECTS of 0 to 2. They cited the post hoc design, moderate sample size, possible selection bias, predominant MRI use, and restriction to patients able to reach the center within 6.5 hours as limitations.

Source: Seners P, ter Schiphorst A, Labreuche J, et al. Mechanical thrombectomy versus medical management for large ischemic core stroke identified before inter-hospital transfer: a post hoc analysis of the LASTE trial. Ann Neurol. Published online September 22, 2026. doi:10.1002/ana.78363