{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T13:10:59Z","timestamp":1790082659364,"version":"4.0.1"},"reference-count":21,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Neurology"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study assessed the efficacy of thrombectomy in acute ischemic stroke because of large\u2010vessel occlusion (AIS\u2010LVO) initially admitted to primary stroke centers (PSC) and subsequently transferred to a comprehensive stroke center (CSC), with a large ischemic core identified before transfer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a post hoc analysis of the Large Stroke Therapy Evaluation (LASTE) randomized controlled trial, which compared medical management (MM) plus thrombectomy and MM alone in anterior circulation AIS\u2010LVO patients with a large core (Alberta Stroke Program Early Computed Tomography Score [ASPECTS], 0\u20135) treated within 6.5\u2009hours of last seen well. This analysis included patients whose baseline imaging was obtained at a PSC and already demonstrated an ASPECTS of 0 to 5, before inter\u2010hospital transfer. The primary outcome was a 90\u2010day functional outcome, assessed using the modified Rankin Scale (mRS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among the 324 patients enrolled in LASTE, 157 were included in this analysis, 80 received MM alone, and 77 underwent thrombectomy plus MM. Median age was 73\u2009years, National Institutes of Health Stroke Scale score was 20, last seen well\u2010to\u2010PSC imaging time 120\u2009minutes and ASPECTS on PSC imaging was 0 to 2 in 56% and 3 to 5 in 44%. Thrombectomy resulted in better functional outcomes than MM alone (generalized odds ratio, 1.71; 95% confidence interval [CI], 1.21\u20132.41;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002), without heterogeneity across ASPECTS strata. Mortality at 90\u2009days was numerically lower in the thrombectomy group (relative risk\u2009=\u20090.73; 95% CI\u2009=\u20090.50\u20131.05), whereas symptomatic intracranial hemorrhage was numerically more frequent (relative risk\u2009=\u20091.85; 95% CI\u2009=\u20090.64\u20135.26).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>These findings support consideration of inter\u2010hospital transfer for EVT in AIS\u2010LVO patients with large ischemic cores (including ASPECT, 0\u20132) admitted to PSCs who can reach the CSC in the early time\u2010window. ANN NEUROL 2026<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ana.78363","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T12:29:08Z","timestamp":1790080148000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Mechanical Thrombectomy Versus Medical Management for Large Ischemic Core Stroke Identified before Inter\u2010Hospital Transfer: A Post Hoc Analysis of the\n                    <scp>LASTE<\/scp>\n                    Trial"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2134-0691","authenticated-orcid":false,"given":"Pierre","family":"Seners","sequence":"first","affiliation":[{"name":"Neurology Department H\u00f4pital Fondation A. de Rothschild  Paris France"},{"name":"Universit\u00e9 Paris Cit\u00e9, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Team Turc  Paris France"},{"name":"Stroke\u2010Link F\u2010CRIN Research Network  Lille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrien","family":"ter Schiphorst","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris Cit\u00e9, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Team Turc  Paris France"},{"name":"Stroke\u2010Link F\u2010CRIN Research Network  Lille France"},{"name":"Neurology Department CHRU Gui de Chauliac  Montpellier France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julien","family":"Labreuche","sequence":"additional","affiliation":[{"name":"Stroke\u2010Link F\u2010CRIN Research Network  Lille France"},{"name":"Biostatistics Lille University Hospital  Lille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bertrand","family":"Lapergue","sequence":"additional","affiliation":[{"name":"Stroke\u2010Link F\u2010CRIN Research Network  Lille France"},{"name":"Department of Neurology H\u00f4pital Foch  Suresnes France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilde","family":"Henon","sequence":"additional","affiliation":[{"name":"Department of Neurology H\u00f4pital Salengro, Centre Hospitalier Universitaire Lille  Lille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nasreddine","family":"Nouri","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology H\u00f4pital Salengro, Centre Hospitalier Universitaire Lille  Lille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8424-4464","authenticated-orcid":false,"given":"Benjamin","family":"Gory","sequence":"additional","affiliation":[{"name":"Stroke\u2010Link F\u2010CRIN Research Network  Lille France"},{"name":"Department of Neuroradiology, H\u00f4pital central, L'unit\u00e9 d'Imagerie Adaptative Diagnostique et Interventionnelle, INSERM Unit\u00e9  Nancy France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00e9bastien","family":"Richard","sequence":"additional","affiliation":[{"name":"Stroke\u2010Link F\u2010CRIN Research Network  Lille France"},{"name":"CHRU\u2010Nancy, Department of Neurology Stroke Unit, Universit\u00e9 de Lorraine, INSERMU1116  Nancy France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean\u2010Fran\u00e7ois","family":"Albucher","sequence":"additional","affiliation":[{"name":"Department of Neurology, H\u00f4pital Pierre Paul Riquet and Toulouse Clinical Investigations Centers  Toulouse France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christophe","family":"Cognard","sequence":"additional","affiliation":[{"name":"Stroke\u2010Link F\u2010CRIN Research Network  Lille France"},{"name":"Neuroradiology Department Toulouse University Hospital  Toulouse France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liesjet E.H.","family":"van Dokkum","sequence":"additional","affiliation":[{"name":"Neuroradiology Department, Montpellier University Hospital  Montpellier France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5109-8736","authenticated-orcid":false,"given":"David S.","family":"Liebeskind","sequence":"additional","affiliation":[{"name":"Department of Neurology UCLA  Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tudor G.","family":"Jovin","sequence":"additional","affiliation":[{"name":"Cooper Neurological Institute and Cooper Medical School of Rowan University  Camden NJ USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Costalat","sequence":"additional","affiliation":[{"name":"Neuroradiology Department, Montpellier University Hospital  Montpellier France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Arquizan","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris Cit\u00e9, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Team Turc  Paris France"},{"name":"Stroke\u2010Link F\u2010CRIN Research Network  Lille France"},{"name":"Neurology Department CHRU Gui de Chauliac  Montpellier France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the LASTE investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1161\/STROKEAHA.124.049167","article-title":"Interfacility transfer for Thrombectomy: a promising therapeutic window","volume":"56","author":"Seners P","year":"2025","journal-title":"Stroke"},{"key":"e_1_2_11_3_1","doi-asserted-by":"crossref","unstructured":"SenersP KyhengM LabreucheJ et al.Inter\u2010Hospital transfer for thrombectomy: transfer time is brain.2024;31:e16276.","DOI":"10.1111\/ene.16276"},{"key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1001\/jamaneurol.2017.2149","article-title":"Clinical imaging factors associated with infarct progression in patients with ischemic stroke during transfer for mechanical Thrombectomy","volume":"74","author":"Boulouis G","year":"2017","journal-title":"JAMA Neurol"},{"key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1002\/ana.26613","article-title":"Determinants of infarct Core growth during inter\u2010hospital transfer for Thrombectomy","volume":"93","author":"Seners P","year":"2023","journal-title":"Ann Neurol"},{"key":"e_1_2_11_6_1","doi-asserted-by":"crossref","DOI":"10.1212\/WNL.0000000000209814","article-title":"Clinical and imaging features associated with fast infarct growth during Interhospital transfers of patients with large vessel occlusions","volume":"103","author":"Wouters A","year":"2024","journal-title":"Neurology"},{"key":"e_1_2_11_7_1","doi-asserted-by":"crossref","DOI":"10.1212\/WNL.0000000000213443","article-title":"Endovascular Thrombectomy for large ischemic Core stroke: a systematic review and meta\u2010analysis of randomized controlled trials","volume":"104","author":"Liu C","year":"2025","journal-title":"Neurology"},{"key":"e_1_2_11_8_1","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1001\/jamaneurol.2024.0206","article-title":"Endovascular Thrombectomy treatment effect in direct vs transferred patients with large ischemic strokes: a Prespecified analysis of the SELECT2 trial","volume":"81","author":"Sarraj A","year":"2024","journal-title":"JAMA Neurol"},{"key":"e_1_2_11_9_1","doi-asserted-by":"crossref","first-page":"1677","DOI":"10.1056\/NEJMoa2314063","article-title":"Trial of Thrombectomy for stroke with a large infarct of unrestricted size","volume":"390","author":"Costalat V","year":"2024","journal-title":"N Engl J Med"},{"key":"e_1_2_11_10_1","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1177\/17474930231191033","article-title":"Evaluation of acute mechanical revascularization in large stroke (ASPECTS \u2a7d5) and large vessel occlusion within 7\u2009h of last\u2010seen\u2010well: the LASTE multicenter, randomized, clinical trial protocol","volume":"19","author":"Costalat V","year":"2024","journal-title":"Int J Stroke"},{"key":"e_1_2_11_11_1","doi-asserted-by":"crossref","first-page":"2356","DOI":"10.1161\/STROKEAHA.111.619122","article-title":"Optimal end points for acute stroke therapy trials: best ways to measure treatment effects of drugs and devices","volume":"42","author":"Saver JL","year":"2011","journal-title":"Stroke"},{"key":"e_1_2_11_12_1","doi-asserted-by":"crossref","first-page":"2981","DOI":"10.1161\/STROKEAHA.115.010049","article-title":"The Heidelberg bleeding classification: classification of bleeding events after ischemic stroke and reperfusion therapy","volume":"46","author":"Kummer R","year":"2015","journal-title":"Stroke"},{"key":"e_1_2_11_13_1","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/S0140-6736(07)60149-4","article-title":"Thrombolysis with alteplase for acute ischaemic stroke in the safe implementation of thrombolysis in stroke\u2010monitoring study (SITS\u2010MOST): an observational study","volume":"369","author":"Wahlgren N","year":"2007","journal-title":"Lancet"},{"key":"e_1_2_11_14_1","doi-asserted-by":"crossref","DOI":"10.4324\/9780203771587","volume-title":"Statistical power analysis for the behavioral sciences","author":"Cohen J","year":"2013"},{"key":"e_1_2_11_15_1","doi-asserted-by":"crossref","first-page":"2509","DOI":"10.1002\/sim.3639","article-title":"Should baseline be a covariate or dependent variable in analyses of change from baseline in clinical trials?","volume":"28","author":"Liu GF","year":"2009","journal-title":"Stat Med"},{"key":"e_1_2_11_16_1","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/S1474-4422(25)00478-8","article-title":"Door\u2010in\u2010door\u2010out times and outcomes in patients with acute ischaemic stroke transferred for endovascular therapy in the USA: a retrospective cohort study","volume":"25","author":"Royan R","year":"2026","journal-title":"Lancet Neurol"},{"key":"e_1_2_11_17_1","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1001\/jamaneurol.2017.0477","article-title":"Association of a Primary Stroke Center Protocol for suspected stroke by large\u2010vessel occlusion with efficiency of care and patient outcomes","volume":"74","author":"McTaggart RA","year":"2017","journal-title":"JAMA Neurol"},{"key":"e_1_2_11_18_1","doi-asserted-by":"crossref","first-page":"1795","DOI":"10.1001\/jama.2022.5948","article-title":"Association between use of a flying intervention team vs patient Interhospital transfer and time to endovascular Thrombectomy among patients with acute ischemic stroke in nonurban Germany","volume":"327","author":"Hubert GJ","year":"2022","journal-title":"JAMA"},{"key":"e_1_2_11_19_1","doi-asserted-by":"crossref","first-page":"3495","DOI":"10.1161\/STROKEAHA.120.030248","article-title":"Mobile interventional stroke team model improves early outcomes in large vessel occlusion stroke: the NYC MIST trial","volume":"51","author":"Morey JR","year":"2020","journal-title":"Stroke"},{"key":"e_1_2_11_20_1","first-page":"e316","article-title":"2026 guideline for the early Management of Patients with Acute Ischemic Stroke: a guideline from the American Heart Association\/American Stroke Association","volume":"57","author":"Prabhakaran S","year":"2026","journal-title":"Stroke"},{"key":"e_1_2_11_21_1","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1001\/jamaneurol.2021.2385","article-title":"Direct to angiography suite without stopping for computed tomography imaging for patients with acute stroke: a randomized clinical trial","volume":"78","author":"Requena M","year":"2021","journal-title":"JAMA Neurol"},{"issue":"1","key":"e_1_2_11_22_1","doi-asserted-by":"crossref","DOI":"10.1093\/esj\/23969873251349713","article-title":"Hemorrhagic transformation during inter\u2010hospital transfer for thrombectomy: incidence, associated factors, and relationship with outcome","volume":"11","author":"Seners P","year":"2026","journal-title":"Eur Stroke J"}],"container-title":["Annals of Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ana.78363","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ana.78363","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ana.78363","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T12:29:13Z","timestamp":1790080153000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ana.78363"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,22]]},"references-count":21,"alternative-id":["10.1002\/ana.78363"],"URL":"https:\/\/doi.org\/10.1002\/ana.78363","archive":["Portico"],"relation":{},"ISSN":["0364-5134","1531-8249"],"issn-type":[{"value":"0364-5134","type":"print"},{"value":"1531-8249","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,22]]},"assertion":[{"value":"2026-05-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-31","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"ana.78363"}}