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Trial of Thrombectomy for Stroke with a Large Infarct of Unrestricted Size.

N Engl J Med

May 2024

From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Neurology (H.H.) and Neuroradiology (N.N.), Hôpital Salengro, and the Department of Biostatistics, Centre Hospitalier Universitaire (CHU) Lille (A.D., J.L.), Lille, the Department of Neuroradiology, Hôpital central, L'unité d'Imagerie Adaptative Diagnostique et Interventionnelle, INSERM Unité 1254 (B. Gory), and the Department of Neurology, Hôpital central, Centre d'investigation clinique Plurithématique 1433, INSERM Unité 1116 (S.R.), Nancy, the Departments of Neuroradiology (G.M.) and Neurology (I.S.), Hôpital Pellegrin, Bordeaux, the Department of Neuroradiology, Hôpital Foch, Suresnes (F.D.M.), the Departments of Neurology (M.A.) and Neuroradiology (G.B.), Hôpital Bretonneau, Tours, the Departments of Neurology (M.O.) and Neuroradiology (M.P.), Hôpital Fondation Adolphe de Rothschild, the Departments of Neurology (G.T.) and Neuroradiology (O.N.), Groupe Hospitalier Universitaire Paris, Centre Hospitalier Sainte-Anne, INSERM Unité 1266, the Departments of Neuroradiology (F.C.) and Neurology (S.A.), Hôpital La Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), the Departments of Neuroradiology (L. Spelle) and Neurology (C.D.), Hôpital Bicêtre, AP-HP, the Departments of Neurology (M. Mazighi) and Neuroradiology (E.H.), Hôpital Lariboisière AP-HP, and INSERM Unité 1266 (C.A.), Paris, the Department of Neuroradiology, Nantes Université, CHU Nantes (R.B.), INSERM Unité Mixte de Recherche 1087, Centre National de la Recherche Scientifique, University of Nantes, L'institut du Thorax (R.B.), and Clinique Neurologique, Hôpital G.R. Laennec CHU Nantes (B. Guillon), Nantes, the Departments of Neurology (S.G.) and Neuroradiology (A.P.-P.), CHU d'Angers, Angers, the Departments of Neuroradiology (O.F.E.) and Neurology (T.-H.C.), Hospices Civils de Lyon, Groupement Hospitalier Est Hôpital Pierre Wertheimer, Lyon, the Departments of Neuroradiology (S.V.) and Neurology (M.L.), CHU Poitiers, Site de La Milétrie, Poitiers, the Stroke Unit (L. Suissa) and the Department of Neuroradiology (H.B.), Assistance Publique-Hôpitaux de Marseille, Hôpital de la Timone, Marseille, the Departments of Neuroradiology (J.-C.G.) and Neurology (S.T.), Centre Hospitalier Régional Universitaire (CHRU) Brest, Hôpital de la Cavale Blanche, Brest, the Departments of Neurology (C.L.) and Neuroradiology (C. Chivot), CHU Amiens-Picardie, Amiens, the Departments of Neurology (F.M.-M.) and Neuroradiology (C.M.), CHU Limoges, Dupuytren, Limoges, the Departments of Neurology (O.O.-W.) and Neuroradiology (C.P.), CHU Rouen, Rouen, the Departments of Neurology (V.W.) and Neuroradiology (R.P.), CHRU Strasbourg, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Strasbourg, the Departments of Neurology (A.F.) and Neuroradiology (E.C.), CHU Clermont-Ferrand, Hôpital Gabriel Montpied, Clermont-Ferrand, the Departments of Neuroradiology (F.R.) and Neurology (Y.B.), CHU Dijon-Bourgogne, Hôpital François Mitterrand, Dijon, and the Department of Neurology, Hôpital Foch, Suresnes (B.L.), and the Department of Neurology, Hôpital Gui de Chauliac, Montpellier (C.A.) - all in France; Cooper Neurological Institute and Cooper Medical School of Rowan University, Camden, NJ (T.G.J.); the Department of Neurology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (P.C.), and the Department of Neurology, Hospital Clínic de Barcelona (A.R.), Barcelona, the Department of Radiology, Hospital Universitario Central de Asturias, Oviedo (E.L.-C., P.V.), the Department of Neurology Hospital Germans Trias i Pujol, Badalona (M. Millán), Hospital Clínico Universitario de Valladolid, Valladolid (J.F. Arenillas), and the Department of Neurology, Hospital Universitario Cruces, Baracaldo (M.M.F.) - all in Spain; and the Department of Neurology, University of Southern California (N.S.), and the Department of Neurology, UCLA (D.S.L.) - both in Los Angeles.

Background: The use of thrombectomy in patients with acute stroke and a large infarct of unrestricted size has not been well studied.

Methods: We assigned, in a 1:1 ratio, patients with proximal cerebral vessel occlusion in the anterior circulation and a large infarct (as defined by an Alberta Stroke Program Early Computed Tomographic Score of ≤5; values range from 0 to 10) detected on magnetic resonance imaging or computed tomography within 6.5 hours after symptom onset to undergo endovascular thrombectomy and receive medical care (thrombectomy group) or to receive medical care alone (control group).

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Background And Purpose: A survival advantage among individuals with higher body mass index (BMI) has been observed for diverse acute illnesses, including stroke, and termed the obesity paradox. However, prior ischemic stroke studies have generally tested only for linear rather than nonlinear relations between body mass and outcome, and few studies have investigated poststroke functional outcomes in addition to mortality.

Methods: We analyzed consecutive patients with acute ischemic stroke enrolled in a 60-center acute treatment trial, the NIH FAST-MAG acute stroke trial.

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