TESLA Trial Turns Positive for Stroke Thrombectomy in Extended Analysis

A recent analysis of the TESLA stroke trial indicates that early mechanical thrombectomy may lead to improved stroke outcomes over a one-year period. In the extended study, patients who received CT-selected endovascular therapy (EVT) for large-core infarcts had better functional results compared to those who received standard medical management alone.

These outcomes, which included lower mean utility-weighted modified Rankin Scale scores and higher likelihoods of functional independence and independent ambulation, were consistent with results reported in the SELECT2 and TENSION trials. The TESLA study used a more pragmatic approach by requiring only noncontrast CT for infarct size estimation and CT angiography for target vessel occlusion, without additional advanced imaging techniques.

This allowed for a broader patient population and a more flexible entry window, which may have contributed to the observed benefits. The study also found that patient-reported quality of life was better among those who received EVT at one year. While there was an increased risk of symptomatic intracranial hemorrhage associated with EVT, the overall all-cause mortality rates were not significantly different between the two groups.

The authors emphasize that their exploratory findings warrant further investigation as a lower-barrier strategy for global stroke systems.