Highlights From the 2025 World Stroke Congress - Part 2

In part two of this two-part series on this year's World Stroke Congress, Dr. Andy Southerland and Dr. Seemant Chaturvedi discuss the ATLAS meta-analysis. 

Learn more on the World Stroke Congress website. 

Show transcript: 

Dr. Andy Southerland: Hello everyone and welcome to this week's Neurology Minute. For this series, I've been speaking again with my friend and colleague, Seemant Chaturvedi, who is the director of the stroke program at the University of Maryland. And as always, Seemant is sharing hot off the presses results of presentations from this year's World Stroke Congress that was held in Barcelona, Spain in October. And for this Neurology Minute, he is going to be sharing with us the presentation of the ATLAS meta-analysis, a systematic review which looked at pulled data from multiple clinical trials and patients presenting with large vessel occlusions and large ischemic cores, looking at folks randomized between endovascular therapy and best medical management. So Seemant, what were the results of the ATLAS meta-analysis?

Dr. Seemant Chaturvedi: So this was a meta-analysis of six clinical trials, which looked at patients with large core infarcts, and they evaluated the results in patients who were treated with endovascular therapy or medical therapy, and it included over 1,800 patients. The primary outcome was the shift analysis on the 90-day modified Rankin Scale, and this was favorable for a thrombectomy with an adjusted odds ratio of 1.63. In terms of the specific outcomes for modified Rankin of zero to two, this was seen in 20% with thrombectomy, 7.5% with medical therapy, for modified Rankin of zero to three, 37% with thrombectomy, and 20% with medical therapy. One important observation was that the mortality was lower with thrombectomy, 31% compared to 37%.

Also, two other points worth mentioning, the cerebral hemorrhage rate was increased with thrombectomy compared to medical therapy 5.5 to 2.7%, and then we frequently wondered how big of an infarct will no longer benefit from thrombectomy. And so here, Dr. Sarraj presented the results and showed that there seemed to be some benefit up to 149 mLs and no benefit in 150 mLs or above. And so I think this gives us a lot of useful information in terms of material we can bring back to our emergency rooms for discussion with our interventional teams about who to treat, who not to treat, and about what are the realistic expectations. And so we look forward to the full publication.

Dr. Andy Southerland: Well, thank you, Seemant, and it's nice to see that this full pooled analysis of these randomized clinical trials not only supports the finding of most of the individual trials, but also enhances it through increased sample size and data across trials. So as you point out, we'll look forward to the peer reviewed publication, but glad to be presented with these new data. And once again, thank you for joining us for this week's Neurology Minute, sharing your observations from the World Stroke Congress in Barcelona, Spain in October. Seek out the full podcast where we discuss these studies and more.