LASTE
Trial question
What is the role of endovascular thrombectomy in patients with AIS with a large infarct of unrestricted size presenting within 6.5 hours after symptom onset?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
48.0% female
52.0% male
N = 324
324 patients (154 female, 170 male).
Inclusion criteria: patients with proximal cerebral vessel occlusion in the anterior circulation with a large infarct presented within 6.5 hours after symptom onset.
Key exclusion criteria: intracerebral hemorrhage; absence of vascular access; contrast or endovascular product life-threatening allergy; pregnancy/lactation; severe or fatal comorbidities or life expectancy < 6 months.
Interventions
N=159 thrombectomy (endovascular thrombectomy and medical care).
N=165 medical care (medical care alone).
Primary outcome
Median Modified Rankin Scale score at day 90
4 points
6 points
6.0 points
4.5 points
3.0 points
1.5 points
0.0 points
Thrombectomy
Medical
care
Significant
decrease ▼
Significant decrease in median mRS score at day 90 (4 points vs. 6 points; OR 0.61, 95% CI 0.49 to 0.77).
Secondary outcomes
Significant decrease in median mRS score at day 180 (4 points vs. 6 points; OR 0.58, 95% CI 0.46 to 0.74).
No significant difference in the rate of decompressive craniectomy within 7 days (8.8% vs. 11.5%; HR 0.81, 95% CI 0.37 to 1.74).
Significant increase in early neurologic improvement (30.7% vs. 11.4%; RR 2.62, 95% CI 1.7 to 4.56).
Safety outcomes
Significant differences in symptomatic intracerebral hemorrhage (9.6% and 5.7%; aRR 1.73, 95% CI 0.78-4.68), death from any cause at day 90 (36.1% vs. 55.5%; aRR 0.65, 95% CI 0.50-0.84).
Conclusion
In patients with proximal cerebral vessel occlusion in the anterior circulation with a large infarct presented within 6.5 hours after symptom onset, thrombectomy was superior to medical care with respect to median mRS score at day 90.
Reference
Vincent Costalat, Tudor G Jovin, J F Albucher et al. Trial of Thrombectomy for Stroke with a Large Infarct of Unrestricted Size. N Engl J Med. 2024 May 9;390(18):1677-1689.
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