WSO - January 2024 - 114

1191033
WSO
International Journal of StrokeCostalat et al.
Protocol
Evaluation of acute mechanical
revascularization in large stroke
(ASPECTS ⩽5) and large vessel
occlusion within 7 h of last-seen-well:
The LASTE multicenter, randomized,
clinical trial protocol
Vincent Costalat1, Bertrand Lapergue2, JF Albucher3, Julien
Labreuche4, Hilde Henon5, Benjamin Gory6 , Igor Sibon7,
Grégoire Boulouis8 , Christophe Cognard9, Nasreddine Nouri10,
Sebastien Richard11, Gauthier Marnat12 , Federico Di Maria13,
Mariam Annan14, Alain Duhamel4, Federico Cagnazzo1,
Tudor Jovin15 and Caroline Arquizan16
; for the LASTE Trial
Investigators
Abstract
Rationale: Mechanical thrombectomy (MT), the standard of care for acute ischemic stroke (AIS) secondary to large
vessel occlusion (LVO), is generally not offered to patients with large baseline infarct (core). Recent studies demonstrated
MT benefit in patients with anterior circulation stroke and large core (i.e. Alberta Stroke Program Early Computed
Tomography Score, ASPECTS 3-5). However, its benefit in patients with the largest core (ASPECTS 0-2) remains
unproven.
Aim: To compare the efficacy and safety of MT plus best medical treatment (BMT) and of BMT alone in patients with
ASPECTS 0-5 (baseline computed tomography (CT) or magnetic resonance imaging (MRI)) and anterior circulation LVO
within 7 h of last-seen-well.
Sample size estimate: To detect with a two-sided test at 5% significance level (80% power) a common odds ratio of
1.65 for 1-point reduction in the 90-day modified Rankin Scale (mRS) score in the MT + BMT arm versus BMT arm and
to anticipate 10% of patients with missing primary endpoint, 450 patients are planned to be included by 36 centers in
France, Spain, and the United States.
1Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier, France
2Department of Neurology, Hôpital Foch, Suresnes, France
3Department of Neurology, Hôpital Pierre-Paul Riquet, Toulouse, France
4Department of Biostatistics, Lille University Hospital, Lille, France
5Department of Neurology, Hôpital Salengro, Lille, France
6Department of Neuroradiology, Hôpital Central, Nancy, France
7Department of Neurology, Hôpital Pellegrin, Bordeaux, France
8Department of Neuroradiology, Hôpital Bretonneau, Tours, France
9Department of Neuroradiology, Hôpital Pierre-Paul Riquet, Toulouse, France
10Department of Neuroradiology, Hôpital Salengro, Lille, France
11Department of Neurology, Hôpital Central, Nancy, France
12Department of Neuroradiology, Hôpital Pellegrin, Bordeaux, France
13Department of Neuroradiology, Hôpital Foch, Suresnes, France
14Department of Neurology, Hôpital Bretonneau, Tours, France
15Cooper Neurological Institute, Camden, NJ, USA
16Department of Neurology, Hôpital Gui de Chauliac, Montpellier, France
Corresponding author:
Caroline Arquizan, Department of Neurology, Hôpital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier, Cedex 5, France.
Email: c-arquizan@chu-montpellier.fr
International Journal of Stroke, 19(1)
International Journal of Stroke
2024, Vol. 19(1) 114 -119
© 2023 World Stroke Organization
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DOI: 10.1177/17474930231191033
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WSO - January 2024

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