Endovascular thrombectomy for acute ischemic stroke with a large infarct area: an updated systematic review and meta-analysis of randomized controlled trials

• DOI: 10.1101/2024.04.02.24305181
• Publication Date: 2024-04-03T17:25:26Z
• Authors: Shivani Ravipati; Ayesha Amjad; Komal Zulfiqar; Hannah Biju; Wajeeh Hassan; Haider Mumtaz Jafri; Ali Husnain; Ibrahim Tahir; Muaaz Aslam; Sharib Afzal; Muhammad Ehsan; Huzaifa Ahmad Cheema; Muhammad Ayyan; Wajeeh Ur Rehman; Sourbha S. Dani
• Keywords: Male; Aged, 80 and over; Time Factors; Endovascular Procedures; Recovery of Function; Middle Aged; Disability Evaluation; 03 medical and health sciences; Treatment Outcome; Functional Status; 0302 clinical medicine; Risk Factors; Humans; Female; Thrombectomy; Randomized Controlled Trials as Topic; Ischemic Stroke; Aged

AbstractBackgroundSince the efficacy and safety of endovascular thrombectomy (EVT) in patients with acute ischemic stroke with a large infarct area is still inconclusive, we sought to compare functional and neurological outcomes with the use of endovascular thrombectomy versus medical care alone.MethodsWe searched MEDLINE (via PubMed), Embase, Cochrane Library, ClinicalTrials.gov, and the International Clinical Trials Registry Platform (ICTRP) to retrieve all the relevant randomized controlled trials (RCTs) on this topic. Review manager (RevMan) was used to perform meta-analyses using a random-effect model. Dichotomous outcomes were pooled using risk ratios (RR) with 95% confidence intervals (CIs).ResultsOur meta-analysis included 6 RCTs with a total of 1665 patients. Most studies included patients with an ASPECTS score of 3-5. Our results demonstrate that endovascular thrombectomy significantly increased the rates of functional independence (mRS ≤ 2) (RR, 2.49; 95% CI, 1.89-3.29) and moderate neurological outcome (mRS ≤ 3) (RR, 1.90; 95% CI, 1.50-2.40) at 90 days. The benefit of EVT for these outcomes remained the same at 1-year follow-up.. Endovascular thrombectomy was associated with increased rates of early neurological improvement (RR, 2.22; 95% CI, 1.53-3.22), excellent neurological recovery (mRS ≤ 1) (RR, 1.75; 95% CI, 1.02-3.03), and decreased rate of poor neurological recovery (mRS 4-6) (RR, 0.81; 95% CI, 0.76-0.86). No significant difference was found between the two groups regarding all-cause mortality (RR, 0.86; 95% CI, 0.72-1.02), decompressive craniectomy (RR, 1.32; 95% CI, 0.89-1.94), and the incidence of serious adverse effects (RR, 1.39; 95% CI, 0.83-2.32) between the two groups. Endovascular thrombectomy significantly increased the rates of any intracranial hemorrhage (RR, 1.94; 95% CI, 1.48-2.53) and symptomatic intracranial hemorrhage (RR, 1.73; 95% CI, 1.11-2.69).ConclusionEndovascular thrombectomy (EVT) significantly improves neurological and functional outcomes in patients with acute ischemic stroke with a large infarct area (ASPECTS 3-5) compared to medical therapy alone, with an increased risk of symptomatic intracranial hemorrhage.