A major advance on stroke at Montpellier University Hospital published in the New England Journal of Medicine

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CHU de Montpellier

09 May, 2024, 07:00 GMT

Coordinated by Montpellier University Medical Center, France, the international study IN EXTREMIS-LASTE, representing a groundbreaking contribution to stroke research was published today in the New England Journal of Medicine.

MONTPELLIER, France, May 9, 2024 /PRNewswire/ -- "LASTE" (LArge Stroke Therapy Evaluation), a prospective, randomized, controlled trial co-led by Professor Vincent Costalat (neuroradiologist, Montpellier, France) and Dr. Caroline Arquizan (vascular neurologist, Montpellier, France), in addition to Dr. Bertrand Lapergue (vascular neurologist, Hospital Foch, Paris, France) and Prof. Tudor Jovin (interventional and vascular neurologist, Cooper University Hospital, Camden, NJ, USA)  has the potential to disrupt current systems of care involving triage and management of patients with acute stroke due to large vessel occlusion by demonstrating that even those patients with the largest areas of "irreversibly" damaged brain as assessed by state-of-the-art imaging technologies still benefit from mechanical reperfusion.

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From left to right, Caroline Arquizan, MD, Chief of Neurovascular Department of University Hospital of Montpellier, France, Vincent Costalat, MD, PhD, Professor of Radiology and Chief of Neuroradiology Department of University Hospital of Montpellier, France Prof. Tudor Jovin, Chair of the Neurology Department of Cooper University Medical Center in Camden, New Jersey, USA Bertrand Lapergue, MD, PhD, Chief of Neurology and Neurovascular Department from Hospital Foch in Paris, France
From left to right, Caroline Arquizan, MD, Chief of Neurovascular Department of University Hospital of Montpellier, France, Vincent Costalat, MD, PhD, Professor of Radiology and Chief of Neuroradiology Department of University Hospital of Montpellier, France Prof. Tudor Jovin, Chair of the Neurology Department of Cooper University Medical Center in Camden, New Jersey, USA Bertrand Lapergue, MD, PhD, Chief of Neurology and Neurovascular Department from Hospital Foch in Paris, France
Illustration of LASTE clinical trial learnings - Brain parts that brain imaging suggests is dead may not entirely be so. Vincent Costalat, MD, PhD, Professor of Radiology and Chief of Neuroradiology Department of University Hospital of Montpellier, France Les enseignements de l’étude LASTE - Les parties du cerveau que l’on croyait détruites d’après les imageries cérébrales ne le sont pas entièrement. Vincent Costalat, MD, PhD, Professor of Radiology and Chief of Neuroradiology Department of University Hospital of Montpellier, France
Illustration of LASTE clinical trial learnings - Brain parts that brain imaging suggests is dead may not entirely be so. Vincent Costalat, MD, PhD, Professor of Radiology and Chief of Neuroradiology Department of University Hospital of Montpellier, France Les enseignements de l’étude LASTE - Les parties du cerveau que l’on croyait détruites d’après les imageries cérébrales ne le sont pas entièrement. Vincent Costalat, MD, PhD, Professor of Radiology and Chief of Neuroradiology Department of University Hospital of Montpellier, France

Trial of Thrombectomy for Stroke with a Large Infract of Unrestrited Size, published in the New England Journal of Medicine https://www.nejm.org/

Since mechanical thrombectomy, a technique that aims to restore blood flow in stroke patients who experience sudden occlusion of a brain artery, by removing the blockage with device-based technologies, became standard of care in 2015, physicians selected for such intervention only stroke patients who displayed limited amounts of brain damage on brain imaging. This was based on the principle that restoration of blood flow to large areas of irreversibly damaged brain  is not only futile but can also cause additional damage due to an increased risk of bleeding in the brain among other detrimental effects of reperfusion. 

Yet, an international network of stroke centers led by the Montpellier University Hospital investigators has proven the opposite. The multicenter therapeutic trial "LASTE" was conducted in France (26 centers) and Spain (7 centers) for 3 years. The trial aimed to select patients hitherto considered "irrecoverable" in common practice due to unrestrictedly large areas of irreversibly compromised brain presenting with acute stroke due to large vessel occlusion within 7 hours of stroke onset to test the hypothesis that reperfusion of brain tissue considered dead could improve their outcome not only in term of survival but also in terms of functional recovery.

IN EXTREMIS TRIALS LASTE and MOSTE are sponsored by an Industrial unrestricted grant co-founded by 5 industrial partners (BALT, CERENOVUS, MEDTRONIC, MICROVENTION, STRYKER).

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Contacts :
v-costalat@chu-montpellier.fr
c-arquizan@chu-montpellier.fr