TESLA
Trial question
What is the role of endovascular thrombectomy in patients with a large infarct on non-contrast CT within 24 hours of stroke onset?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
46.0% female
54.0% male
N = 300
300 patients (138 female, 162 male).
Inclusion criteria: patients aged 18-85 years presenting within 24 hours with anterior circulation large vessel occlusion and a large infarct on non-contrast CT.
Key exclusion criteria: ICH; mass effect with ventricular effacement; midline shift or herniation; tandem cervical internal carotid artery occlusion.
Interventions
N=152 endovascular thrombectomy (endovascular treatment using standard thrombectomy devices and usual medical care).
N=148 usual care (usual medical care alone).
Primary outcome
Mean utility-weighted modified Rankin Scale score at day 90
2.93 points
2.27 points
2.9 points
2.2 points
1.5 points
0.7 points
0.0 points
Endovascular
thrombectomy
Usual
care
No significant
difference ↔
No significant difference in mean utility-weighted mRS score at day 90 (2.93 points vs. 2.27 points; AD 0.63 points, 95% CI -0.09 to 1.34).
Secondary outcomes
No significant difference in median mRS score at day 90 (5 points vs. 5 points; RR 1.4, 95% CI 0.91 to 2.16).
No significant difference in median NIHSS score after 24 hours (19 points vs. 18 points; AD 1 points, 95% CI -1 to 3).
Borderline significant increase in median quality-of-life health score at day 90 (60 points vs. 50 points; AD 10 points, 95% CI 0 to 15).
Safety outcomes
No significant differences in 90-day mortality, symptomatic ICH at 24 hours, neurological deterioration within 6 days, and decompressive hemicraniectomy.
Conclusion
In patients aged 18-85 years presenting within 24 hours with anterior circulation large vessel occlusion and a large infarct on non-contrast CT, endovascular thrombectomy was not superior to usual care with respect to mean utility-weighted mRS score at day 90.
Reference
Writing Committee for the TESLA Investigators, Albert J Yoo, Osama O Zaidat et al. Thrombectomy for Stroke With Large Infarct on Noncontrast CT: The TESLA Randomized Clinical Trial. JAMA. 2024 Sep 23;332(16):1355-1366. Online ahead of print.
Open reference URL