Meta-analysis of previous studies: MAGNA
Another presentation at the ESOC meeting reported an individual patient data meta-analysis (MAGNA) of the three previous trials suggesting benefit of thrombectomy in patients with large-core ischemic strokes of the anterior circulation up to 24 hours of last known well.
The RESCUE Japan Limit trial was conducted in Japan; the SELECT-2 trial in North America, Europe, Australia, and New Zealand; and the ANGEL ASPECT trial in China.
In total, the meta-analysis included 1,009 patients, half of whom received thrombectomy and half received medical management only.
Results showed that in the whole population in the three trials, the use of thrombectomy improved functional outcomes, with an adjusted odds ratio of 1.78 (P < .001).
Functional independence (mRS 0-2) was also increased (23% vs. 9%; adjusted risk ratio, 2.62; P < .001); as was independent ambulation (mRS, 0-3; 41% vs. 24%; aRR, 1.76; P < .001).
But early neurological worsening was more frequent with thrombectomy (aRR 1.42, 1.09-1.84, P = .010).
No difference in mortality was identified between thrombectomy (27%) and medical management (28%) or in rates of symptomatic ICH (1.8% thrombectomy vs. 1.6% medical management).
“The results from the previously published large-core trials and from this pooled dataset provide unequivocal evidence on the efficacy and safety of endovascular thrombectomy in patients with large-core infarcts,” lead author of the MAGNA meta-analysis, Amrou Sarraj, MD, professor of neurology at University Hospitals Cleveland Medical Center, affiliate of Case Western Reserve University in Cleveland, concluded.
“The benefit persists across the spectrum of age, clinical severity, and time, with clear benefit up to an estimated ischemic core volume of 150 mL,” he added. “We have great hopes that these results will lead to more patients being treated and achieving improved functional outcomes.”
On how the TESLA results fit in with the previous three trials, Dr. Sarraj pointed out to this news organization that the TESLA trial was conducted in the United States and enrolled patients based on ASPECTS 2-5 on noncontrast CT.
“The primary outcome for intention-to-treat analysis did not reach the prespecified threshold for efficacy, but the results were largely in the same direction as shown in SELECT2, ANGEL ASPECT, and RESCUE Japan Limit,” he said. “These findings further emphasize the efficacy and safety of thrombectomy in patients with large ischemic core, at the same time reinforcing the need to provide results from pooled data from all large-core trials.”
He noted that results from two further trials of thrombectomy in large core strokes, TENSION and LASTE – both of which have now been stopped early because of the positive findings from the previous studies – are expected soon, and the MAGNA meta-analysis will be updated to include data from all six trials.
“This will increase the accuracy of the estimation of the treatment effect and will give even more power to look further into the details related to subgroups and selection imaging modalities,” Dr. Sarraj added.
The research team hopes that this joint effort will eventually set the pathway for selection algorithms and treatment boundaries in patients with large-vessel occlusion.
TESLA was an investigator-initiated study funded by unrestricted grants from Cerenovus, Penumbra, Medtronic, Stryker, and Genentech. Dr. Zaidat is a consultant for Stryker, Cerenovus, Penumbra, and Medtronic.
A version of this article first appeared on Medscape.com.