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Peer-reviewedCC BYEuropean stroke journal

Functional outcomes and quality of life after endovascular thrombectomy in large and extensive infarcts (ASPECTS 0-5): a multicentre registry study.

  • Hannah Asperger1,2
  • Felix J Bode1
  • Taraneh Ebrahimi1,2
  • Lara Klehr1
  • Julia Layer1,2
  • Julius Meißner1
  • Louisa Nitsch1,3
  • Omid Shirvani1,2
  • Christian S Thielscher1,2
  • Niklas M von Danwitz1,2
  • Svenja Odensaß4
  • Sebastian Stösser1
4 more authors
  • Franziska Dorn4
  • Gabor C Petzold1,2
  • Johannes Weller1,3,5
  • GSR-ET Investigators
5 affiliations
  1. 1Department of Vascular Neurology, University Hospital Bonn, Bonn, Germany.
  2. 2German Center for Neurodegenerative Diseases (DZNE) Bonn, Bonn, Germany.
  3. 3Department of Neuroimmunology, University Hospital Bonn, Bonn, Germany.
  4. 4Department of Neuroradiology, University Hospital Bonn, Bonn, Germany.
  5. 5Department of Neurooncology, University Hospital Bonn, Bonn, Germany.
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Abstract

Introduction

Endovascular thrombectomy (EVT) is established for large infarcts, but remains cautiously applied in extensive infarcts with an Alberta Stroke Program Early CT Score (ASPECTS) of 0-2. Real-life outcome data remain limited.Patients and methods

Retrospective analysis of the German Stroke Registry-Endovascular Treatment comparing extensive (ASPECTS 0-2) and large infarcts (ASPECTS 3-5) in patients with anterior-circulation occlusion and EVT. The primary outcome was the ordinal 90-day mRS distribution; secondary outcomes were mRS 0-3, survival, quality of life (3-level European Quality of Life-5 Dimensions) and living condition.Results

Of 18,069 screened patients, 889 were analysed (ASPECTS 1-2, n = 89; ASPECTS 3-5, n = 800); none had ASPECTS 0. With ASPECTS 1-2, 20.2% achieved mRS 0-3 and 55.1% died within 90 days. In the model including successful reperfusion, no statistically significant association was detected between infarct group and the 90-day mRS distribution (common odds ratio [cOR] 0.80; 95% CI, 0.53-1.23) or mRS 0-3 (adjusted odds ratio [aOR] 0.89; 95% CI, 0.64-1.25), whereas successful reperfusion was associated with both (cOR 3.68; 95% CI, 2.31-5.85 and aOR 4.10; 95% CI, 2.45-6.86). Among survivors, median European Quality of Life-5 Dimensions utility index was 0.445 vs 0.541 (n = 27/324), and 51.5% vs 50.9% lived at home (n = 33/411).Discussion

An extensive infarct carried a challenging prognosis, yet acceptable outcome and non-institutional living remained achievable in a relevant minority. An independent association of infarct group with outcome was not detected.Conclusion

An acceptable outcome remained attainable in selected patients with extensive infarction, particularly after successful reperfusion. Lacking a medically managed comparator, these data describe prognosis rather than treatment effect.

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Cite

BibTeXRIS
BibTeX
@article{asperger2026functional,
  title = {{Functional outcomes and quality of life after endovascular thrombectomy in large and extensive infarcts (ASPECTS 0-5): a multicentre registry study.}},
  author = {Hannah Asperger and Felix J Bode and Taraneh Ebrahimi and Lara Klehr and Julia Layer and Julius Meißner and Louisa Nitsch and Omid Shirvani and Christian S Thielscher and Niklas M von Danwitz and Svenja Odensaß and Sebastian Stösser and Franziska Dorn and Gabor C Petzold and Johannes Weller and GSR-ET Investigators},
  journal = {European stroke journal},
  year = {2026},
  month = nov,
  doi = {10.1093/esj/aakag131},
  url = {https://europepmc.org/article/MED/42969847},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Functional outcomes and quality of life after endovascular thrombectomy in large and extensive infarcts (ASPECTS 0-5): a multicentre registry study.
AU  - Hannah Asperger
AU  - Felix J Bode
AU  - Taraneh Ebrahimi
AU  - Lara Klehr
AU  - Julia Layer
AU  - Julius Meißner
AU  - Louisa Nitsch
AU  - Omid Shirvani
AU  - Christian S Thielscher
AU  - Niklas M von Danwitz
AU  - Svenja Odensaß
AU  - Sebastian Stösser
AU  - Franziska Dorn
AU  - Gabor C Petzold
AU  - Johannes Weller
AU  - GSR-ET Investigators
PY  - 2026
DA  - 2026/11/01
JO  - European stroke journal
DO  - 10.1093/esj/aakag131
UR  - https://europepmc.org/article/MED/42969847
AB  - Introduction  Endovascular thrombectomy (EVT) is established for large infarcts, but remains cautiously applied in extensive infarcts with an Alberta Stroke Program Early CT Score (ASPECTS) of 0-2. Real-life outcome data remain limited.Patients and methods  Retrospective analysis of the German Stroke Registry-Endovascular Treatment comparing extensive (ASPECTS 0-2) and large infarcts (ASPECTS 3-5) in patients with anterior-circulation occlusion and EVT. The primary outcome was the ordinal 90-day mRS distribution; secondary outcomes were mRS 0-3, survival, quality of life (3-level European Quality of Life-5 Dimensions) and living condition.Results  Of 18,069 screened patients, 889 were analysed (ASPECTS 1-2, n = 89; ASPECTS 3-5, n = 800); none had ASPECTS 0. With ASPECTS 1-2, 20.2% achieved mRS 0-3 and 55.1% died within 90 days. In the model including successful reperfusion, no statistically significant association was detected between infarct group and the 90-day mRS distribution (common odds ratio [cOR] 0.80; 95% CI, 0.53-1.23) or mRS 0-3 (adjusted odds ratio [aOR] 0.89; 95% CI, 0.64-1.25), whereas successful reperfusion was associated with both (cOR 3.68; 95% CI, 2.31-5.85 and aOR 4.10; 95% CI, 2.45-6.86). Among survivors, median European Quality of Life-5 Dimensions utility index was 0.445 vs 0.541 (n = 27/324), and 51.5% vs 50.9% lived at home (n = 33/411).Discussion  An extensive infarct carried a challenging prognosis, yet acceptable outcome and non-institutional living remained achievable in a relevant minority. An independent association of infarct group with outcome was not detected.Conclusion  An acceptable outcome remained attainable in selected patients with extensive infarction, particularly after successful reperfusion. Lacking a medically managed comparator, these data describe prognosis rather than treatment effect.
SN  - 2396-9873
SN  - 2396-9881
ER  -