{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T21:45:57Z","timestamp":1792014357975,"version":"4.4.0"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Several trials have shown the benefit and safety of endovascular therapy (EVT) compared with medical management (MM) of patients with a large ischemic core in the 90-day follow-up. However, the 1-year outcome comparison between EVT and MM in Asian patients with a large ischemic core has not been investigated. Our aim was to evaluate the 1-year outcomes of patients in the ANGEL-ASPECT trial (Endovascular Therapy in Acute Anterior Circulation Large Vessel Occlusive Patients with a Large Infarct Core).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>\n                      In this phase 3, randomized, open-label, blinded end point assessment trial, patients with anterior circulation large vessel occlusion and an Alberta Stroke Program Early CT Score of 3 to 5 or an infarct core volume of 70 to 100 mL were enrolled across 46 hospitals in China. Patients were randomly assigned 1:1 to EVT or MM. The 90-day outcomes were previously reported. We report a prespecified analysis of the ANGEL-ASPECT trial, with 1-year functional outcome as the primary outcome in this study. The primary outcome was the shift of the modified Rankin Scale (mRS) score (range, 0\u20136, with a higher score reflecting greater disability) to better outcomes at 1-year. The secondary outcomes included functional independence (mRS score, 0\u20132), independent ambulation (mRS score, 0\u20133), and mortality. This trial is registered with\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      (Unique identifier: NCT04551664).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      One-year data were available for 425 of 455 (93%) patients for the primary outcome, with 214 patients in the EVT group and 211 in the MM group in the complete case analysis. The mean age was 66 years, and 38.1% were female. There was a greater likelihood of shift toward improved 1-year mRS distribution in the EVT compared with the MM group (generalized odds ratio, 1.25 [95% CI, 1.01\u20131.56];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.04). Functional independence and independent ambulation were higher in the EVT compared with MM groups (mRS score, 0\u20132: 30.4% [65\/214] versus 17.1% [36\/211]; relative risk, 1.87 [95% CI, 1.27\u20132.75]; mRS score, 0\u20133: 50.0% [107\/214] versus 35.6% [75\/211]; relative risk, 1.46 [95% CI, 1.15\u20131.85], respectively). The 1-year mortality rate was 31.3% (67\/214) in the EVT group and 26.5% (56\/211) in the MM group (relative risk, 1.12 [95% CI, 0.82\u20131.53]). In addition, no change was found in the rate of functional independence between 90 days and 1 year in the EVT group (29.4% [69\/214] versus 30.4% [65\/214], respectively); however, a gain in functional independence was observed in the MM group from 90 days to 1 year (10.9% [26\/211] versus 17.1% [36\/211]), narrowing the magnitude of EVT treatment effect from 18.5% at 90 days to 13.3% at 1 year.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>In patients with large ischemic stroke from a proximal arterial occlusion presenting within 24 hours of onset, EVT reduced disability with durable 1-year benefit compared with MM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT04551664.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.124.050086","type":"journal-article","created":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T18:00:41Z","timestamp":1756144841000},"page":"2398-2407","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Endovascular Therapy Versus Medical Management for Large Ischemic Infarct: 1-Year Outcomes of the ANGEL-ASPECT Trial"],"prefix":"10.1161","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1264-5132","authenticated-orcid":true,"given":"Xiaochuan","family":"Huo","sequence":"first","affiliation":[{"name":"Cerebrovascular Disease Department, Neurological Disease Center, Beijing Anzhen Hospital (X.H., X.T., X.Z., S. Li), Capital Medical University, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6321-5381","authenticated-orcid":true,"given":"Dapeng","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Neurology, Interventional Neuroradiology (D.S., Y.P., F.G., N.M., D.M., Z.M.), Beijing Tiantan Hospital, Capital Medical University, China."},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing (D.S., Y.P., F.G., N.M., D.M., L.L., Y.W., Z.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2810-1685","authenticated-orcid":true,"given":"Thanh N.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Radiology, Boston Medical Center, MA (T.N.N., M.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9374-7589","authenticated-orcid":true,"given":"Gaoting","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Neurology, Beijing Xuanwu Hospital (G.M.), Capital Medical University, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3082-6789","authenticated-orcid":true,"given":"Yuesong","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Neurology, Interventional Neuroradiology (D.S., Y.P., F.G., N.M., D.M., Z.M.), Beijing Tiantan Hospital, Capital Medical University, China."},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing (D.S., Y.P., F.G., N.M., D.M., L.L., Y.W., Z.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4893-1299","authenticated-orcid":true,"given":"Xin","family":"Tong","sequence":"additional","affiliation":[{"name":"Cerebrovascular Disease Department, Neurological Disease Center, Beijing Anzhen Hospital (X.H., X.T., X.Z., S. Li), Capital Medical University, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1813-5005","authenticated-orcid":true,"given":"Guangxiong","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Emergency, Xiangtan Central Hospital, Hunan, China (G.Y.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongxing","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Neurology, Linyi People\u2019s Hospital, Shandong, China (H.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7031-8917","authenticated-orcid":true,"given":"Wenhuo","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, China (W.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9612-5577","authenticated-orcid":true,"given":"Ming","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tianjin Huanhu Hospital, China (M.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiangang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Anyang People\u2019s Hospital, Henan, China (J. Zhang)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiming","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Neurology, Yijishan Hospital of Wannan Medical College, Anhui, China (Z.Z.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoxi","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of Neurology, The First People\u2019s Hospital of Chenzhou, Hunan, China (X.Y.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weigen","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Neurology, Yancheng Third People\u2019s Hospital, Jiangsu, China (W.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0296-1166","authenticated-orcid":true,"given":"Xueli","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Neurology, Lishui Municipal Central Hospital, Zhejiang, China (X. Cai)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7427-6892","authenticated-orcid":true,"given":"Guangxian","family":"Nan","sequence":"additional","affiliation":[{"name":"Department of Neurology, China-Japan Union Hospital of Jilin University, Jilin (G.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2009-5740","authenticated-orcid":true,"given":"Di","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurointervention, Dalian Municipal Central Hospital of Dalian University of Technology, Liaoning, China (D.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alvin Yi-Chou","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The First Hospital of Hebei Medical University, China (A.Y.-C.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wentong","family":"Ling","sequence":"additional","affiliation":[{"name":"Department of Neurology, Zhongshan City People\u2019s Hospital, Guangdong, China (W.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuwei","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Neurology, Shantou Central Hospital, Guangdong, China (C.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changming","family":"Wen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Nanyang Central Hospital, Henan, China (C.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"En","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Taizhou Hospital of Zhejiang Province, Zhejiang, China (E.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liyong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Liaocheng People\u2019s Hospital, Shandong, China (L.Z.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7345-0198","authenticated-orcid":true,"given":"Changchun","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Baotou Central Hospital, Inner Mongolia, China (C.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geng","family":"Liao","sequence":"additional","affiliation":[{"name":"Department of Neurology, Maoming People\u2019s Hospital, Guangdong, China (G.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohui","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangdong, China (X. 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