{
  "abstract": "Background Evidence from randomized clinical trials shows that mechanical thrombectomy (MT) enhances functional outcomes in patients with large core ischemic stroke.Objective To evaluate trends in the use of revascularization therapies, particularly MT, and their impact on functional outcomes in patients with large core ischemic stroke in routine clinical settings.Methods Observational data from the Stroke Code Registry of Catalonia (CICAT, 2016–2024) were analyzed. Patients with anterior circulation ischemic stroke and Alberta Stroke Program Early CT Score (ASPECTS) <6, whether treated with reperfusion therapies or not, were included. Statistical analyses included trend analysis and multivariable logistic regression to identify predictors of favorable outcomes (modified Rankin Scale score 0–3 at 90 days) and mortality.Results Among 599 patients, MT use increased significantly from 22% pre-2022 to 36% post-2022. This increase was associated with improved functional outcomes, with favorable outcomes rising from 29% to 43% post-2022. MT was a significant independent predictor of favorable outcomes (OR 3.4, 95% CI 2.1 to 5.5) and reduced mortality (OR 0.46, 95% CI 0.32 to 0.68). Intravenous thrombolysis also improved outcomes (OR 2.1, 95% CI 1.3 to 3.5). The benefit of MT was consistent across ASPECTS subgroups (0–2 and 3–5). Mediation analysis indicated that 88% of improvement could be attributed to increased MT use.Conclusions Increased MT use significantly improved outcomes for patients with large core ischemic stroke, particularly after 2022. Benefits were observed across subgroups, including those with very low ASPECTS. These findings support broadening MT access and suggest the need to update treatment guidelines to consider patients with large ischemic cores, aiming to optimize outcomes in routine clinical practice.",
  "authors": [
    {
      "affiliations": [
        "Universidad de Barcelona Facultad de Medicina y Ciencias de La Salud, Barcelona, Spain",
        "Stroke Unit, Department of Neurology, Hospital Clinic de Barcelona, Barcelona, Spain",
        "Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain"
      ],
      "name": "Antonio Doncel-Moriano Cubero"
    },
    {
      "affiliations": [
        "Universidad de Barcelona Facultad de Medicina y Ciencias de La Salud, Barcelona, Spain",
        "Stroke Unit, Department of Neurology, Hospital Clinic de Barcelona, Barcelona, Spain",
        "Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain"
      ],
      "name": "Alejandro Rodríguez-Vázquez"
    },
    {
      "affiliations": [
        "Stroke Unit, Department of Neurology, Hospital Clinic de Barcelona, Barcelona, Spain"
      ],
      "name": "Irene Rosa"
    },
    {
      "affiliations": [
        "Stroke Unit, Department of Neurology, Hospital Clinic de Barcelona, Barcelona, Spain",
        "Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain"
      ],
      "name": "Salvatore Rudilosso"
    },
    {
      "affiliations": [
        "Stroke Unit, Department of Neurology, Hospital Clinic de Barcelona, Barcelona, Spain"
      ],
      "name": "Mònica Serrano"
    },
    {
      "affiliations": [
        "Stroke Unit, Department of Neurology, Hospital Clinic de Barcelona, Barcelona, Spain",
        "Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain"
      ],
      "name": "Arturo Renú"
    },
    {
      "affiliations": [
        "Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain"
      ],
      "name": "Andrea Cabero-Arnold"
    },
    {
      "affiliations": [
        "Department of Interventional Neuroradiology, Hospital Clínic Barcelona, Barcelona, Spain"
      ],
      "name": "Jordi Blasco"
    },
    {
      "affiliations": [
        "Universidad de Barcelona Facultad de Medicina y Ciencias de La Salud, Barcelona, Spain",
        "Stroke Unit, Department of Neurology, Hospital Clinic de Barcelona, Barcelona, Spain",
        "Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain"
      ],
      "name": "Sergi Amaro"
    },
    {
      "affiliations": [
        "Stroke Unit, Department of Neurology, Hospital Clinic de Barcelona, Barcelona, Spain",
        "Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain"
      ],
      "name": "Laura Llull"
    },
    {
      "affiliations": [
        "Department of Neurology, Vall d’Hebron Research Institute, Barcelona, Spain"
      ],
      "name": "Carlos A Molina"
    },
    {
      "affiliations": [
        "Stroke Unit, Department of Neurology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Catalunya, Spain"
      ],
      "name": "Pere Cardona Portela"
    },
    {
      "affiliations": [
        "Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain"
      ],
      "name": "Pol Camps-Renom"
    },
    {
      "affiliations": [
        "Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Spain"
      ],
      "name": "Mónica Millan"
    },
    {
      "affiliations": [
        "Stroke Unit, Department of Neurology, Parc Taulí Hospital Universitari, Sabadell, Spain"
      ],
      "name": "Georgina Figueras-Aguirre"
    },
    {
      "affiliations": [
        "Stroke Unit, Department of Neurology, Hospital del Mar, Hospital del Mar Research Institute, Barcelona, Spain"
      ],
      "name": "Ana Rodríguez-Campello"
    },
    {
      "affiliations": [
        "Stroke Unit, Department of Neurology, Hospital Universitari Josep Trueta, Girona, Spain"
      ],
      "name": "Yolanda Silva"
    },
    {
      "affiliations": [
        "Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova, Lleida, Spain"
      ],
      "name": "Francisco Purroy"
    },
    {
      "affiliations": [
        "Stroke Programme, Catalan Health Department, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain"
      ],
      "name": "Mercè Salvat"
    },
    {
      "affiliations": [
        "Stroke Unit, Department of Neurology, Hospital Clinic de Barcelona, Barcelona, Spain"
      ],
      "name": "Martha Vargas"
    },
    {
      "affiliations": [
        "Universidad de Barcelona Facultad de Medicina y Ciencias de La Salud, Barcelona, Spain",
        "Stroke Unit, Department of Neurology, Hospital Clinic de Barcelona, Barcelona, Spain",
        "Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain"
      ],
      "name": "Xabier Urra"
    },
    {
      "affiliations": [
        "Universidad de Barcelona Facultad de Medicina y Ciencias de La Salud, Barcelona, Spain",
        "Stroke Unit, Department of Neurology, Hospital Clinic de Barcelona, Barcelona, Spain",
        "Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain"
      ],
      "name": "Ángel Chamorro"
    },
    {
      "affiliations": [],
      "name": "On behalf of on behalf of the Catalan Stroke Code Registry (Cat-SCR) Consortium"
    }
  ],
  "title": "Trends in revascularization therapies for patients with acute stroke with large infarcts: a population-based study",
  "uid": "6ba992ee-0cd6-5056-a49c-44cadc323ffa"
}