A study published in ‘NEJM’ expands the range of stroke patients who can benefit from thrombectomy

A study with the participation of the Stroke Unit of the Bellvitge University Hospital and the IDIBELL Neurological Diseases and Neurogenetics group published in the scientific journal The New England Journal of Medicine shows that even stroke patients with extensive areas of brain damage can benefit of being treated with mechanical thrombectomy.


This finding questions the previous idea that certain brain lesions were irreversible and thus opens new perspectives in the treatment of stroke, so that many more patients will have the option to benefit from the positive results of mechanical thrombectomy.


The study, titled IN EXTREMIS-LASTE, involved the participation of 26 hospitals in France and 7 in Spain, with a total of 333 patients included in the research. The research, led by Montpellier University Hospital, has seen significant contributions from Bellvitge University Hospital in Spain, which provided the highest number of patients for the study.


Thrombectomy is a technique to restore blood flow in stroke patients by removing the obstruction with mechanical procedures that became the standard treatment as of 2015. However, as a rule, the intervention is restricted only to patients who suffer only brain damage. This criterion has been based on the assumption that restoration of blood flow in large and irreversibly damaged areas of the brain was not only futile, but could even cause additional damage due to the increased risk of hemorrhage, among other harmful effects of reperfusion. However, the international network of stroke centers in which Bellvitge Hospital and IDIBELL participate has been demonstrating the opposite.


The IN EXTREMIS-LASTE trial selected patients who until now were considered “unrecoverable” in routine practice due to large vessel occlusion and extensive damage to brain tissue, who were treated with mechanical thrombectomy during the 7 hours after the stroke.


The conclusions indicate that the magnitude of the benefit is very considerable and similar to that observed in patients who had moderate or small amounts of brain damage. Furthermore, it has been one of the few mechanical thrombectomy trials that has demonstrated the benefits of this procedure in terms of mortality.


From the work, it is clear that up to 20% more patients with stroke with large vessel occlusion – previously considered ineligible – will be able to benefit from mechanical thrombectomy.


According to the study’s lead researchers, one explanation for these results may be that the part of the brain that imaging studies suggest is dead is not actually dead. In these regions, it is suggested that islands of surviving brain tissue may persist, which could potentially be salvaged through reperfusion. These findings are in line with those of other recently published studies.


According to Dr. Pere Cardona, IDIBELL researcher and neurologist at Bellvitge University Hospital, this study “may represent an important change in the management criteria of patients with acute strokes with large occlusion, and also opens a new field of research in models to better understand neuronal death and the recovery capacities of brain tissue in the acute phase of a stroke.”


Original paper:
Trial of Thrombectomy for Stroke with a Large Infarct of Unrestricted Size. Costalat V, Jovin TG, Albucher JF, Cognard C, Henon H, Nouri N, Gory B, Richard S, Marnat G, Sibon I, Di Maria F, Annan M, Boulouis G, Cardona P, Obadia M, Piotin M, Bourcier R, Guillon B, Godard S, Pasco-Papon A, Eker OF, Cho TH, Turc G, Naggara O, Velasco S, Lamy M, Clarençon F, Alamowitch S, Renu A, Suissa L, Brunel H, Gentric JC, Timsit S, Lamy C, Chivot C, Macian-Montoro F, Mounayer C, Ozkul-Wermester O, Papagiannaki C, Wolff V, Pop R, Ferrier A, Chabert E, Ricolfi F, Béjot Y, Lopez-Cancio E, Vega P, Spelle L, Denier C, Millán M, Arenillas JF, Mazighi M, Houdart E, Del Mar Freijo M, Duhamel A, Sanossian N, Liebeskind DS, Labreuche J, Lapergue B, Arquizan C; LASTE Trial Investigators. N Engl J Med. 2024 May 9;390(18):1677-1689. doi: 10.1056/NEJMoa2314063.

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