# Endovascular thrombectomy versus medical management on outcomes with infarct volumes more than 70 mL

## TL;DR

This study compares outcomes of endovascular thrombectomy versus medical treatment in stroke patients with large infarct volumes, finding no significant benefit from the procedure.

## Contribution

The study provides real-world evidence on EVT outcomes for large infarct volumes (>70 mL) in acute ischemic stroke.

## Key findings

- EVT was not associated with improved functional independence compared to medical management.
- There was no significant difference in mortality rates between the EVT and non-EVT groups.
- Propensity score adjustments confirmed no benefit of EVT in this patient population.

## Abstract

Endovascular thrombectomy (EVT) in patients with large infarct volume remains controversial. The aim of this study is to compare clinical outcomes between EVT and medical management in acute large vessel occlusion with infarct volumes larger than 70 mL on diffusion‐weighted magnetic resonance imaging (DWI).

A prospective observational cohort study was conducted, including patients with anterior cerebral circulation occlusion due to ischemic stroke with infarct volumes larger than 70 mL within 24 h of onset between July 2018 and June 2023. Eligible patients were divided into two groups: the EVT group and the medical management (non‐EVT) group. The main outcomes were functional independence and mortality at 90 days. To assess clinical endpoints, we selected variables including age, NIHSS score, infarct volume, and occlusion location for 1:1 propensity score (PS) matching and PS adjustment using inverse probability of treatment weighting (IPTW).

Among the 131 identified patients (mean [SD] age, 69.9 [13.7] years; 58 female), the median infarct volume was 123.6 mL. Of these patients, 75 (57.3%) underwent EVT. After PS adjustment, EVT was not associated with functional independence (10.9% vs. 10.9%; p = 1.000) or mortality (43.5% vs. 47.8%; p = 0.675). Additionally, after PS adjustment using IPTW, EVT was also not associated with a functional independence (15.8% vs. 13.7%; p = 0.767) or mortality (46.8% vs. 44.0%; p = 0.762).

This study provides real‐world evidence regarding infarct volumes larger than 70 mL, indicating that EVT does not provide benefits compared to medical management alone when considering age, NIHSS score, infarct volume, and occlusion location.