6/28/23, 12:41 AM ANGEL-ASPECT Pathway Feedback Search Clinical Topics Home Studies ANGEL ASPECT ANGEL ASPECT Disease Acute ischemic stroke Trial question What is the role of endovascular therapy in patients with acute ischemic stroke with large infarction? Study design Multi-center Open label RCT Population Characteristics of study participants 39.0% female N = 455 61.0% male 455 patients (176 female, 279 male) Inclusion criteria: adult patients, aged 18-80 years, with ischemic stroke within the previous 24 hours Key exclusion criteria: midline shift or clinical signs of herniation; mass effect; high risk of hemorrhage; acute bilateral strokes; or multiple intracranial occlusions Interventions N=230 endovascular therapy (mechanical thrombectomy, aspiration thrombectomy, intra-arterial thrombolysis, angioplasty or stenting plus medical management) N=225 medical management (standard guideline-directed medical therapy alone) Primary outcome https://web.pathway.md/studies/recvdo8uV6pEmzKxf 1/2 6/28/23, 12:41 AM ANGEL-ASPECT Pathway Modified Rankin scale score at day 90 4.0 4 4 3.0 2.0 1.0 Significant increase 0.0 Endovascular therapy Medical management Significant increase in mRS score at day 90 (4 vs. 4; OR 1.37, 95% CI 1.11 to 1.69) Secondary outcomes Borderline significant increase in mRS score of 0-2 at day 90 (30% vs. 11.6%; RR 2.62, 95% CI 1.69 to 4.06) Borderline significant increase in mRS score of 0-3 at day 90 (47% vs. 33.3%; RR 1.5, 95% CI 1.17 to 1.91) Borderline significant increase in target artery recanalization at 36 hours (85.8% vs. 36.4%; RR 2.46, 95% CI 1.96 to 3.08) Safety outcomes No significant differences in symptomatic intracranial hemorrhage within 48 hours, death within 90 days, decompressive hemicraniectomy during hospitalization. Significant difference in any intracranial hemorrhage within 48 hours (49.1% vs. 17.3%). Conclusion In adult patients, aged 18-80 years, with ischemic stroke within the previous 24 hours, endovascular therapy was superior to medical management with respect to mRS score at day 90. Reference Xiaochuan Huo, Gaoting Ma, Xu Tong et al. Trial of Endovascular Therapy for Acute Ischemic Stroke with Large Infarct. N Engl J Med. 2023 Apr 6;388(14):1272-1283. Open reference URL https://web.pathway.md/studies/recvdo8uV6pEmzKxf 2/2