One-year follow-up shows functional gains from thrombectomy in severe stroke

A one-year follow-up analysis of a multicenter clinical trial published in JAMA indicates that patients with severe ischemic strokes caused by large-core infarcts experienced better long-term functional outcomes after endovascular thrombectomy compared with medical management alone. The original trial, which assessed outcomes at 90 days, did not show a meaningful benefit from the procedure.

The study enrolled patients at 47 U.S. stroke centers who presented within 24 hours of symptom onset and had large strokes identified by noncontrast CT imaging. At one year, 23.6% of patients treated with thrombectomy achieved functional independence, compared with 6.8% in the medical-management group. Independent walking was regained by 35.4% of the thrombectomy group versus 18% of the control group.

Patients who underwent thrombectomy also reported better quality of life at one year, while one-year mortality rates were similar between the two groups. The findings align with emerging evidence from other large-core stroke trials suggesting that restoring blood flow can benefit patients with extensive brain injury.

Dr. Sameer A. Ansari, a co-author of the study and chief of Interventional Neuroradiology at Northwestern University, said the delayed benefit may reflect the fact that recovery from severe stroke continues well beyond the standard 90-day assessment period used in most trials. He noted that patients in the thrombectomy group continued to improve between 90 days and one year, while outcomes in the medical-management group remained static or declined.

Ansari suggested that restoring blood flow may support long-term neuroplasticity, the brain's ability to reorganize and form new neural connections after injury. He emphasized that more research is needed to identify which large-core stroke patients benefit most from the intervention.

The results may give clinicians additional confidence to offer thrombectomy to patients with severe brain injury, while counseling families that meaningful recovery can require extended time, rehabilitation, and support.