JAMA

Does endovascular thrombectomy improve outcomes within 24 hours of stroke onset?

September 26, 2024

The TESLA trial showed that thrombectomy didn't significantly improve functional outcome at 90 days among patients with large infarct detected by noncontrast CT and presenting within 24 hours.

• The phase 3 trial enrolled 300 patients (46% female; median age, 67 years) at 47 stroke thrombectomy centers. Participants were randomized to thrombectomy or usual care.
• Endovascular therapy conferred no improvement in 90-day functional outcome based on the mean utility-weighted modified Rankin Scale (mRS) (intervention, 2.93 vs. control, 2.27; adjusted difference of 0.63, 95% credible interval, -0.09-1.34).
• 90-day mortality rates were similar between groups: 35.3% for the intervention group vs. 33.3% for the control group. A small number of participants in both groups experienced 24-hour symptomatic intracranial hemorrhage (intervention, 4.0% vs. control, 1.3%)
• More patients in the intervention group (vs. control group) experienced parenchymal hematoma type 1 hemorrhages (9.5% vs. 2.7%) and subarachnoid hemorrhages (16.2% vs. 6.2%).

Source:

The Writing Committee for the TESLA Investigators; et al. (2024, September 23). JAMA. Thrombectomy for Stroke With Large Infarct on Noncontrast CT: The TESLA Randomized Clinical Trial. https://jamanetwork.com/journals/jama/article-abstract/2823962