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Peer-reviewedCC BY 4.0Frontiers in Neurology

Effectiveness of endovascular thrombectomy in large-core ischemic stroke: a real-world cohort study

  • Yu-Chia Chang1,2,3
  • Wei-Chun Wang1,3,4,5
  • Yen-Chung Chen1,6,7,8
  • Kang-Hsu Lin1,2,3,6
  • Chung-Hsiang Liu1,2,3,6
  • Hung-Yu Huang1,2,3,6
  • Chon-Haw Tsai1,3,5,9,10
  • Jui-Cheng Chen1,3,5,6,9,10
10 affiliations
  1. 1Department of Neurology, China Medical University Hospital, China Medical University
  2. 2Division of Stroke and Neurointensive Care, Department of Neurology, China Medical University Hospital, China Medical University
  3. 3Stroke Center, China Medical University Hospital, China Medical University
  4. 4Artificial Intelligence and Robotics Innovation Center, China Medical University Hospital, China Medical University
  5. 5Neuroscience and Brain Disease Center, China Medical University
  6. 6School of Medicine, College of Medicine, China Medical University
  7. 7Department of Neurology, Taichung Municipal Geriatric Rehabilitation General Hospital Managed by China Medical University, China Medical University
  8. 8Graduate Institute of Statistics and Information Science, National Changhua University of Education
  9. 9Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, China Medical University
  10. 10Division of Parkinson's Disease and Movement Disorders, Department of Neurology, China Medical University Hospital, China Medical University
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Abstract

Background: The benefit of endovascular thrombectomy (EVT) for acute ischemic stroke with large infarct cores in real-world practice remains uncertain, especially for patients beyond randomized trial criteria.

Materials and methods: We retrospectively analyzed adult patients (January 2020–September 2024) with anterior-circulation large-vessel occlusion, an NIHSS score of 6–30, and an ASPECTS of 0–5 or infarct core volume ≥70 mL, treated within 24 h. Inverse probability of treatment weighting (IPTW) was used to compare outcomes between EVT and standard medical treatment (SMT). The primary endpoint was functional independence (mRS 0–2) at 90 days.

Results: Among 300 eligible patients, EVT was associated with a higher likelihood of 90-day functional independence compared with SMT (18.0% vs. 5.0%; adjusted risk ratio, 2.82; 95% CI, 1.09–7.32; p = 0.033) and better mRS 0–3 outcomes after IPTW. While any intracranial hemorrhage was more frequent following EVT, the rates of symptomatic intracranial hemorrhage, 90-day mortality, and space-occupying brain edema did not differ significantly between groups. The estimated treatment effect generally favored EVT across the predefined subgroups, and no statistically significant evidence of treatment-effect heterogeneity was detected (all P for interaction > 0.05). However, several subgroup-specific estimates were imprecise, with confidence intervals crossing the null value. Notably, the treatment effect could not be estimated among patients with a baseline mRS ≥ 2 because no patient in this subgroup achieved functional independence.

Conclusion: In real-world practice, EVT within 24 h is associated with a higher likelihood of functional independence for selected patients with large-core stroke. EVT was associated with a higher incidence of any intracranial hemorrhage, although no statistically significant differences were observed in symptomatic intracranial hemorrhage, 90-day mortality, or space-occupying brain edema. Individualized shared decision-making remains important because several subgroup-specific estimates were imprecise, particularly in high-risk populations, indicating the need for further prospective validation.

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Cite

BibTeXRIS
BibTeX
@article{chang2026effectiveness,
  title = {{Effectiveness of endovascular thrombectomy in large-core ischemic stroke: a real-world cohort study}},
  author = {Yu-Chia Chang and Wei-Chun Wang and Yen-Chung Chen and Kang-Hsu Lin and Chung-Hsiang Liu and Hung-Yu Huang and Chon-Haw Tsai and Jui-Cheng Chen},
  journal = {Frontiers in Neurology},
  year = {2026},
  month = nov,
  doi = {10.3389/fneur.2026.1876588},
  url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1876588/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Effectiveness of endovascular thrombectomy in large-core ischemic stroke: a real-world cohort study
AU  - Yu-Chia Chang
AU  - Wei-Chun Wang
AU  - Yen-Chung Chen
AU  - Kang-Hsu Lin
AU  - Chung-Hsiang Liu
AU  - Hung-Yu Huang
AU  - Chon-Haw Tsai
AU  - Jui-Cheng Chen
PY  - 2026
DA  - 2026/11/05
JO  - Frontiers in Neurology
DO  - 10.3389/fneur.2026.1876588
UR  - https://www.frontiersin.org/articles/10.3389/fneur.2026.1876588/full
AB  - Background: The benefit of endovascular thrombectomy (EVT) for acute ischemic stroke with large infarct cores in real-world practice remains uncertain, especially for patients beyond randomized trial criteria.  Materials and methods: We retrospectively analyzed adult patients (January 2020–September 2024) with anterior-circulation large-vessel occlusion, an NIHSS score of 6–30, and an ASPECTS of 0–5 or infarct core volume ≥70 mL, treated within 24 h. Inverse probability of treatment weighting (IPTW) was used to compare outcomes between EVT and standard medical treatment (SMT). The primary endpoint was functional independence (mRS 0–2) at 90 days.  Results: Among 300 eligible patients, EVT was associated with a higher likelihood of 90-day functional independence compared with SMT (18.0% vs. 5.0%; adjusted risk ratio, 2.82; 95% CI, 1.09–7.32; p = 0.033) and better mRS 0–3 outcomes after IPTW. While any intracranial hemorrhage was more frequent following EVT, the rates of symptomatic intracranial hemorrhage, 90-day mortality, and space-occupying brain edema did not differ significantly between groups. The estimated treatment effect generally favored EVT across the predefined subgroups, and no statistically significant evidence of treatment-effect heterogeneity was detected (all P for interaction > 0.05). However, several subgroup-specific estimates were imprecise, with confidence intervals crossing the null value. Notably, the treatment effect could not be estimated among patients with a baseline mRS ≥ 2 because no patient in this subgroup achieved functional independence.  Conclusion: In real-world practice, EVT within 24 h is associated with a higher likelihood of functional independence for selected patients with large-core stroke. EVT was associated with a higher incidence of any intracranial hemorrhage, although no statistically significant differences were observed in symptomatic intracranial hemorrhage, 90-day mortality, or space-occupying brain edema. Individualized shared decision-making remains important because several subgroup-specific estimates were imprecise, particularly in high-risk populations, indicating the need for further prospective validation.
SN  - 1664-2295
ER  -