TESLA Trial Thrombectomy: 1-Year Benefit in Large-Core Stroke

New TESLA trial thrombectomy data show a 1-year benefit for large-core acute ischemic stroke patients. That holds even though the 90-day primary outcome fell short. The research letter ran in JAMA on August 3.

At 1 year, thrombectomy plus medical management hit functional independence at 23.6%. Medical management alone hit 6.8%. Independent ambulation followed the same pattern: 35.4% vs 18.0%.

Lead investigator Osama O. Zaidat, MD, MS, led the analysis. Zaidat directs the Neuroscience and Stroke Program at Mercy Health, St. Vincent Medical Centre, Toledo, Ohio.

"This extended follow-up of the TESLA trial demonstrated that mechanical thrombectomy for large anterior circulation infarcts selected by NCCT [noncontrast CT] resulted in improved functional outcomes and higher patient-reported quality of life at 1 year compared with MM [medical management] alone," Zaidat and colleagues wrote.

"Recovery or decline after large-core stroke may extend beyond 90 days," they added.

What the TESLA trial thrombectomy question was

Patients with large-core infarcts have long fared poorly after acute ischemic stroke. Early thrombectomy trials often left them out. Later trials showed benefit from endovascular therapy in this group. But those trials leaned on advanced multimodal imaging. That imaging is not at every centre.

The TESLA trial thrombectomy design tested the procedure in patients with large-core infarcts. Imaging was noncontrast CT (NCCT) alone. NCCT is far more widely available. The goal: a lower-barrier way to pick patients who might benefit.

Trial design and patient population

TESLA was a multicenter, open-label, blinded endpoint randomised clinical trial. It ran at 47 US stroke centres.

Eligible patients were adults aged 18-85 years. They presented within 24 hours of last known well. Cause: acute ischemic stroke from an internal carotid or middle cerebral artery occlusion.

Additional inclusion rules:

• National Institutes of Health Stroke Scale (NIHSS) score of at least 6.
• Alberta Stroke Program Early Computed Tomography Score (ASPECTS) of 2-5 on baseline NCCT.
• Minimal pre-stroke disability (modified Rankin Scale [mRS] 0-1).

Of 302 patients randomised, 300 entered the intention-to-treat analysis. Split: 152 in thrombectomy plus medical management (median age 66 years), 148 in medical management alone (median age 68 years). At 1 year, 144 and 133 patients had complete functional data. 23 participants withdrew or dropped out.

The 90-day primary outcome did not clear the superiority threshold. The current letter reports 1-year outcomes. That includes the utility-weighted mRS score.

One-year functional outcomes

The 1-year TESLA trial thrombectomy data favoured the procedure. TESLA trial thrombectomy patients achieved a higher mean utility-weighted mRS score than those receiving medical management alone (3.65 vs 2.78). The adjusted mean difference: 1.18 points.

Functional independence (mRS 0-2) was reached in 23.6% of thrombectomy patients vs 6.8% with medical management alone (risk difference 16.8%; P < .001).

Independent ambulation (mRS 0-3) also favoured thrombectomy: 35.4% vs 18.0% (risk difference 17.4%; P < .001).

An ordinal analysis of mRS scores backed the trend, with a common odds ratio of 1.82 (P = .005).

Quality of life and mortality

Patient-reported quality of life was higher in the thrombectomy arm. Mean EQ-5D-5L index scores hit 60.3 vs 49.3 (P = .003).

Mortality at 1 year was similar between the two groups: 43.1% vs 46.6% (risk difference -3.5%; P = .42).

Caveats and what comes next

The investigators asked readers to weigh the results against the neutral 90-day primary outcome. There was no adjustment for multiple comparisons across secondary outcomes.

Still, the team noted the 1-year data. It adds to evidence that recovery after large-core stroke may run beyond the 90-day mark.

"These descriptive data suggest longer-term benefit associated with thrombectomy in large-core stroke," the investigators wrote.

The team added that NCCT-only selection deserves more study. It could be a lower-barrier route for stroke systems worldwide. More work is needed on whether the findings hold in lower-resource settings.

The TESLA trial was funded by unrestricted grants from Medtronic, Cerenovus, Penumbra, Stryker, and Genentech.

For stroke and interventional neurology teams, the TESLA trial thrombectomy update makes the case for a longer follow-up window in large-core stroke care. Coverage on Medigear.uk tracks how data from the TESLA trial are reshaping care.

Source: Originating coverage based on Medscape Medical News reporting on a JAMA research letter published online on August 3, 2026, from the TESLA trial. Lead investigator: Osama O. Zaidat, MD, MS, director of the Neuroscience and Stroke Program at Mercy Health — St. Vincent Medical Center in Toledo, Ohio. Funded by unrestricted grants from Medtronic, Cerenovus, Penumbra, Stryker, and Genentech.