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Even patients with the most severe large-core strokes can benefit from thrombectomy before hospital transfer. A post hoc analysis of the LASTE trial found that stroke patients with large vessel occlusions and large ischemic cores had significantly better functional outcomes at 90 and 180 days when thrombectomy was added to standard medical management. The findings support transferring eligible patients to comprehensive stroke centers for the procedure, even in early time windows.
For stroke patients with large vessel occlusions and significant brain damage already visible on imaging, thrombectomy still delivers meaningful benefits — even when patients need to be transferred between hospitals first. A post hoc analysis of the LASTE randomized controlled trial examined 157 patients with acute ischemic stroke and large ischemic cores (ASPECTS 0–5) identified at primary stroke centers before transfer to comprehensive stroke centers. Patients who received thrombectomy plus medical management fared significantly better than those on medical management alone.
The benefits held up at both 90 and 180 days post-treatment, and were even seen in patients with the most severe core damage (ASPECTS 0–2). Notably, the advantage of thrombectomy in achieving independent ambulation diminished with longer transfer times — underscoring the importance of speed — while medical management outcomes were unaffected by transfer duration.
By the Numbers:
Why it matters: These findings challenge the notion that large-core stroke patients are poor thrombectomy candidates, and support fast-tracking eligible patients — even those with very large infarcts — to comprehensive stroke centers for intervention.
