In this registry analysis of EVT-treated anterior-circulation occlusion, extensive infarcts (ASPECTS 1-2) had a challenging prognosis, but an acceptable outcome and non-institutional living remained achievable in a relevant minority, particularly after successful reperfusion; no independent association of infarct group with outcome was detected, and without a medically managed comparator the data describe prognosis rather than treatment effect.
Of 18,069 screened patients in the German Stroke Registry-Endovascular Treatment, 889 were analysed, and none had ASPECTS 0.
Patients with extensive infarcts (ASPECTS 1-2) had high mortality and a minority achieved acceptable functional outcome at 90 days.
After adjustment including successful reperfusion, no statistically significant association was detected between infarct group (ASPECTS 1-2 vs 3-5) and 90-day functional outcome.
Successful reperfusion was strongly associated with better 90-day functional outcomes.
Among survivors with available data, quality of life was numerically lower in the ASPECTS 1-2 group than the ASPECTS 3-5 group.
About half of survivors with available living-condition data lived at home in both infarct groups.
The data describe prognosis rather than treatment effect because no medically managed comparator was available.
This study used a German registry of stroke patients who underwent clot-removal procedures (thrombectomy) for blockages in the brain's front circulation. It compared patients with very extensive early brain damage on CT scans (scores of 1-2 on the ASPECTS scale) with those with large damage (scores 3-5). Of 889 patients analysed, 89 were in the extensive group. Outcomes in the extensive-damage group were difficult: 55.1% died within 90 days, but about one in five (20.2%) reached a level of function considered acceptable (able to walk with or without help, mRS 0-3). Among survivors with available data, about half lived at home in both groups. After accounting for other factors, including whether blood flow was successfully restored, the study did not detect a statistically significant difference in outcome between the two damage groups. Successful restoration of blood flow was strongly linked to better outcomes. This research suggests that some patients with extensive early damage may still reach acceptable outcomes after thrombectomy, particularly if blood flow is restored. However, the study had no group of patients treated with medication alone, and the extensive group was small with limited quality-of-life data, so it describes expected outcomes rather than proving the procedure's benefit.
Asperger H, Bode F, Ebrahimi T, Klehr L, Layer J, Meißner J, et al.. (2026). Functional outcomes and quality of life after endovascular thrombectomy in large and extensive infarcts (ASPECTS 0-5): a multicentre registry study.. European stroke journal. https://doi.org/10.1093/esj/aakag131