Evidence map›Paper›PMID 38346442›Full record

Trial reportLancet (London, England)2024

Endovascular thrombectomy plus medical care versus medical care alone for large ischaemic stroke: 1-year outcomes of the SELECT2 trial.

Amrou Sarraj, Michael G Abraham, Ameer E Hassan, Spiros Blackburn, Scott E Kasner, Santiago Ortega-Gutierrez, Muhammad Shazam Hussain, Michael Chen, Hannah Johns, Leonid Churilov and 50 more

Registry-linked trialAbstract readRandomized Controlled TrialClinical Trial, Phase III
PubMed Publisher
In one paragraph

Trial report in Lancet (London, England), 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03876457 (SELECT2), which is not on this map. Cited by 30 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
30citing papers in PubMed, 6 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03876457 nacompletednot on this map

SELECT2: A Randomized Controlled Trial to Optimize Patient's Selection for Endovascular Treatment in Acute Ischemic Stroke

TypeinterventionalSponsorUniversity Hospitals Cleveland Medical CenterRan2019 to 2023Enrolled352ConditionsAcute Ischemic StrokeArmsEndovascular Thrombectomy, Medical Management
3 · Its place in the literature

Who cites it

30 citing papers in PubMed, 6 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
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  5. Endovascular thrombectomy for ischemic stroke with large infarct, short- and long-term outcomes: a meta-analysis of 6 randomised control trials.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2024
    Pooled it
  6. Pooled it
  7. Article
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  9. Review
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  11. Extensive ischemic change on stroke presentation is uncommon: A population-based study.Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association · 2025
    Article
  12. Article
  13. Visual Alberta stroke program early computed tomography score versus RAPID-AI perfusion in predicting outcome after late-window thrombectomy.Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2025
    Article
  14. Article
  15. Article
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  17. Article
  18. Current perspectives on endovascular therapy for large core ischemic stroke.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2025
    Review
  19. Review
  20. Long-term functional outcomes for elderly patients treated with endovascular thrombectomy.Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2025
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

60 authors.

Amrou SarrajDepartment of Neurology, University Hospital Cleveland Medical Center, Cleveland, OH, USA; Department of Neurology, Case Western Reserve University, Cleveland, OH, USA. Electronic address: amrou.sarraj@uhhospitals.org.
Michael G AbrahamDepartment of Neurology, University of Kansas Medical Center, Kansas City, KS, USA.
Ameer E HassanDepartment of Neuroscience, Valley Baptist Medical Center, Harlingen, TX, USA.
Spiros BlackburnDepartment of Neurosurgery, McGovern Medical School at UTHealth, Houston, TX, USA.
Scott E KasnerDepartment of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
Santiago Ortega-GutierrezDepartment of Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Muhammad Shazam HussainCerebrovascular Center, Cleveland Clinic, Cleveland, OH, USA.
Michael ChenDepartment of Neurosurgery, Rush University Medical Center, Chicago, IL, USA.
Hannah JohnsDepartment of Medicine and Neurology, University of Melbourne, Parkville, VC, Australia.
Leonid ChurilovDepartment of Medicine and Neurology, University of Melbourne, Parkville, VC, Australia.
Deep K PujaraDepartment of Neurology, University Hospital Cleveland Medical Center, Cleveland, OH, USA; Department of Neurology, Case Western Reserve University, Cleveland, OH, USA.
Faris ShakerDepartment of Neurosurgery, McGovern Medical School at UTHealth, Houston, TX, USA.
Laith MaaliDepartment of Neurology, University of Kansas Medical Center, Kansas City, KS, USA.
Pere Cardona PortelaDepartment of Neurology, Hospital Universitari de Bellvitge, Bellvitge, Spain.
Nabeel A HerialDepartment of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Daniel GibsonDepartment of Neurosurgery, Ascension Wisconsin, Indianapolis, IN, USA.
Osman KozakDepartment of Neurosurgery, Abington Jefferson Health, Abington, PA, USA.
Juan F ArenillasDepartment of Internal Medicine, Hospital Clínico Universitario Valladolid-University of Valladolid, Valladolid, Spain.
Bernard YanDepartment of Medicine and Neurology, University of Melbourne, Parkville, VC, Australia; Department of Internal Medicine and Neurology, Melbourne Brain Center-The Royal Melbourne Hospital, Parkville, VC, Australia.
Natalia Pérez de la OssaDepartment of Neurology, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain.
Sophia SundararajanDepartment of Neurology, University Hospital Cleveland Medical Center, Cleveland, OH, USA; Department of Neurology, Case Western Reserve University, Cleveland, OH, USA.
Yin C HuDepartment of Neurosurgery, University Hospital Cleveland Medical Center, Cleveland, OH, USA; Department of Neurosurgery, Case Western Reserve University, Cleveland, OH, USA.
Dennis J CordatoDepartment of Neurology, Liverpool Hospital, Liverpool, NSW, Australia.
Nathan W ManningDepartment of Neurosurgery, Ingham Institute, Liverpool, NSW, Australia.
Ricardo A HanelDepartment of Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL, USA.
Amin N AghaebrahimDepartment of Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL, USA.
Ronald F BudzikDepartment of Neuro-Interventional Radiology, OhioHealth-Riverside Methodist Hospital, Columbus, OH, USA.
William J HicksDepartment of Neurology, OhioHealth-Riverside Methodist Hospital, Columbus, OH, USA.
Jordi BlascoDepartment of Interventional Radiology, Hospital Clínic de Barcelona, Barcelona, Spain.
Teddy Y WuDepartment of Neurology, Christchurch Hospital, Christchurch, New Zealand.
Jenny P TsaiCerebrovascular Center, Cleveland Clinic, Cleveland, OH, USA.
Joanna D SchaafsmaDepartment of Internal Medicine, Toronto Western Hospital, Toronto, ON, Canada.
Chirag D GandhiDepartment of Neurosurgery, Westchester Medical Center-NY Medical College, Valhalla, NY, USA.
Fawaz Al-MuftiDepartment of Neurosurgery, Westchester Medical Center-NY Medical College, Valhalla, NY, USA.
Navdeep SanghaDepartment of Neurology, Kaiser Permanente Southern California, Los Angeles, CA, USA.
Steven WarachDepartment of Neurology, Dell Medical School at The University of Texas at Austin-Ascension Texas, Austin, TX, USA.
Timothy J KleinigDepartment of Neurology, Royal Adelaide Hospital, Adelaide, SA, Australia.
Vignan YogendrakumarDepartment of Internal Medicine and Neurology, Melbourne Brain Center-The Royal Melbourne Hospital, Parkville, VC, Australia.
Felix NgDepartment of Internal Medicine and Neurology, Melbourne Brain Center-The Royal Melbourne Hospital, Parkville, VC, Australia.
Edgar A SamaniegoDepartment of Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Mohammad A AbdulrazzakCerebrovascular Center, Cleveland Clinic, Cleveland, OH, USA.
Mark W ParsonsDepartment of Neurology, Liverpool Hospital, Liverpool, NSW, Australia.
Mohammad H RahbarDepartment of Internal Medicine, McGovern Medical School at UTHealth, Houston, TX, USA.
Thanh N NguyenDepartment of Neurology, Boston Medical Center, Boston, MA, USA.
Johanna T FifiDepartment of Neurology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
Vitor Mendes PereiraDepartment of Neurology, St Michael's Hospital, Toronto, ON, Canada.
Maarten G LansbergDepartment of Neurology, Stanford University, Stanford, CA, USA.
Greg W AlbersDepartment of Neurology, Stanford University, Stanford, CA, USA.
Anthony J FurlanDepartment of Neurology, University Hospital Cleveland Medical Center, Cleveland, OH, USA; Department of Neurology, Case Western Reserve University, Cleveland, OH, USA.
Pascal JabbourDepartment of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Clark W SittonDepartment of Interventional and Diagnostic Imaging, McGovern Medical School at UTHealth, Houston, TX, USA.
Cathy SilaDepartment of Neurology, University Hospital Cleveland Medical Center, Cleveland, OH, USA; Department of Neurology, Case Western Reserve University, Cleveland, OH, USA.
Nicholas BambakidisDepartment of Neurosurgery, University Hospital Cleveland Medical Center, Cleveland, OH, USA; Department of Neurosurgery, Case Western Reserve University, Cleveland, OH, USA.
Stephen M DavisDepartment of Internal Medicine and Neurology, Melbourne Brain Center-The Royal Melbourne Hospital, Parkville, VC, Australia.
Lawrence WechslerDepartment of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Michael D HillDepartment of Clinical Neuroscience, University of Calgary, Calgary, AB, Canada.
James C GrottaMobile Stroke Unit, Memorial Hermann Hospital, Houston, TX, USA.
Marc RiboDepartment of Neurology, Hospital Vall d'Hebrón, Barcelona, Spain.
Bruce C V CampbellDepartment of Medicine and Neurology, University of Melbourne, Parkville, VC, Australia; Department of Internal Medicine and Neurology, Melbourne Brain Center-The Royal Melbourne Hospital, Parkville, VC, Australia; Department of Medicine and Neurology, The Florey Institute for Neuroscience and Mental Health, Parkville, VC, Australia.
SELECT2 Investigators

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMultiple randomised trials have shown efficacy and safety of endovascular thrombectomy in patients with large ischaemic stroke. The aim of this study was to evaluate long-term (ie, at 1 year) evidence of benefit of thrombectomy for these patients.

methodsSELECT2 was a phase 3, open-label, international, randomised controlled trial with blinded endpoint assessment, conducted at 31 hospitals in the USA, Canada, Spain, Switzerland, Australia, and New Zealand. Patients aged 18-85 years with ischaemic stroke due to proximal occlusion of the internal carotid artery or of the first segment of the middle cerebral artery, showing large ischaemic core on non-contrast CT (Alberta Stroke Program Early Computed Tomographic Score of 3-5 [range 0-10, with lower values indicating larger infarctions]) or measuring 50 mL or more on CT perfusion and MRI, were randomly assigned, within 24 h of ischaemic stroke onset, to thrombectomy plus medical care or to medical care alone. The primary outcome for this analysis was the ordinal modified Rankin Scale (range 0-6, with higher scores indicating greater disability) at 1-year follow-up in an intention-to-treat population. The trial is registered at ClinicalTrials.gov (NCT03876457) and is completed.

findingsThe trial was terminated early for efficacy at the 90-day follow-up after 352 patients had been randomly assigned (178 to thrombectomy and 174 to medical care only) between Oct 11, 2019, and Sept 9, 2022. Thrombectomy significantly improved the 1-year modified Rankin Scale score distribution versus medical care alone (Wilcoxon-Mann-Whitney probability of superiority 0·59 [95% CI 0·53-0·64]; p=0·0019; generalised odds ratio 1·43 [95% CI 1·14-1·78]). At the 1-year follow-up, 77 (45%) of 170 patients receiving thrombectomy had died, compared with 83 (52%) of 159 patients receiving medical care only (1-year mortality relative risk 0·89 [95% CI 0·71-1·11]).

interpretationIn patients with ischaemic stroke due to a proximal occlusion and large core, thrombectomy plus medical care provided a significant functional outcome benefit compared with medical care alone at 1-year follow-up.

fundingStryker Neurovascular.

Indexed as

Brain IschemiaEndovascular ProceduresIschemic StrokeStrokeAlbertaFibrinolytic AgentsHumansThrombectomyTreatment OutcomeFibrinolytic Agents

Identifiers

PMID38346442

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.