ISC 2023 | Endovascular therapy vs medical management for large core ischemic stroke: ANGEL-ASPECT results

The multicenter, randomized, controlled ANGEL-ASPECT trial (NCT04551664) set out to compare the safety and efficacy of endovascular therapy (EVT) versus best medical management (BMM) for patients with acute ischemic stroke due to large vessel occlusion with a large infarct core. To date, there has been a lack of evidence on the optimal management approach in the large core population and consequently, guidelines have limited recommendations for thrombectomy to patients with ASPECTS score ≥6 on non-contrast CT or infarct core volume ≤70 mL in the 0–6-hour time window, and to those fulfilling the DAWN or DEFUSE-3 criteria in the 6–24-hour time window. Principal investigator, Xiaochuan Huo, MD, Beijing Tiantan Hospital, Capital Medical University, Beijing, China, talks through the details of the study. In total, 456 patients were enrolled from 46 centers across China. Participants had ASPECT scores of 3-5 or infarct core volume of 70 to 100 ml and were treated within 24 hours of symptom onset. Mechanical thrombectomy, aspiration thrombectomy, intra-arterial thrombolysis, angioplasty or stenting were all allowed in the trial. The distribution of mRS scores at 90-days shifted towards better outcomes in the EVT arm, compared to those receiving BMM (GenOR 1.37). Rate of any intracranial hemorrhage (ICH) was significantly higher in the EVT arm versus the BMM arm, but there was no significant difference in symptomatic ICH rates. Dr Huo comments on the limitations of the study and the need for more data from ongoing trials. This interview took place during the International Stroke Conference (ISC) 2023 in Dallas, TX.

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